Provider Demographics
NPI:1316594922
Name:PATEL, YAGNESHKUMAR PRAHLADBHAI
Entity Type:Individual
Prefix:
First Name:YAGNESHKUMAR
Middle Name:PRAHLADBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 RADCLIFFE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-6720
Mailing Address - Country:US
Mailing Address - Phone:586-563-5126
Mailing Address - Fax:
Practice Address - Street 1:31904 RYAN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-1339
Practice Address - Country:US
Practice Address - Phone:586-344-4458
Practice Address - Fax:586-314-0574
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist