Provider Demographics
NPI:1326068586
Name:PATEL, HEMANT DASHARATHLAL (PT)
Entity Type:Individual
Prefix:MR
First Name:HEMANT
Middle Name:DASHARATHLAL
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 1:105 SOUTHPARK BLVD STE B201
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5159
Mailing Address - Country:US
Mailing Address - Phone:904-824-1636
Mailing Address - Fax:904-824-7488
Practice Address - Street 1:105 SOUTHPARK BLVD STE B201
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5159
Practice Address - Country:US
Practice Address - Phone:904-824-1636
Practice Address - Fax:904-824-7488
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011729225100000X
IN05008811A225100000X
NY027205225100000X
FLPT29148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400009208Medicare PIN
NYA400020009Medicare PIN