Provider Demographics
NPI:1366461717
Name:PATEL, RAKESHKUMAR (PT)
Entity Type:Individual
Prefix:
First Name:RAKESHKUMAR
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 1:3019 LASALLE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-6021
Mailing Address - Country:US
Mailing Address - Phone:347-419-3233
Mailing Address - Fax:
Practice Address - Street 1:3019 LASALLE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-6021
Practice Address - Country:US
Practice Address - Phone:347-419-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028089261QP2000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy