Provider Demographics
NPI:1275771255
Name:PATEL, HITENDRA BALDEVBHAI (PT)
Entity Type:Individual
Prefix:
First Name:HITENDRA
Middle Name:BALDEVBHAI
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 1:4027 WINDING VINE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-2201
Mailing Address - Country:US
Mailing Address - Phone:678-526-4778
Mailing Address - Fax:678-526-4778
Practice Address - Street 1:3010 OAKBRIDGE BLVD E
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803
Practice Address - Country:US
Practice Address - Phone:678-526-4778
Practice Address - Fax:678-526-4778
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26279225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400001384Medicare PIN