Provider Demographics
NPI:1417359043
Name:PATEL, AJAYKUMAR
Entity Type:Individual
Prefix:
First Name:AJAYKUMAR
Middle Name:
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 1:18502 W BELLFORT ST STE 118
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-9003
Mailing Address - Country:US
Mailing Address - Phone:248-403-1730
Mailing Address - Fax:
Practice Address - Street 1:18502 W BELLFORT ST STE 118
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-9003
Practice Address - Country:US
Practice Address - Phone:248-403-1730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016850225100000X
TX1370987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist