Provider Demographics
NPI:1265866792
Name:PATEL, SAURABH (PT)
Entity Type:Individual
Prefix:
First Name:SAURABH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-7311
Mailing Address - Country:US
Mailing Address - Phone:219-561-0828
Mailing Address - Fax:833-977-1355
Practice Address - Street 1:3710 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7311
Practice Address - Country:US
Practice Address - Phone:219-561-0828
Practice Address - Fax:833-977-1355
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2022-12-05
Deactivation Date:2019-12-14
Deactivation Code:
Reactivation Date:2020-02-26
Provider Licenses
StateLicense IDTaxonomies
MI5501016295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist