Provider Demographics
NPI:1447585500
Name:PATEL, CHIRAG Y (PT)
Entity Type:Individual
Prefix:MR
First Name:CHIRAG
Middle Name:Y
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 1:441 THOMPSON LN
Mailing Address - Street 2:
Mailing Address - City:BRODNAX
Mailing Address - State:VA
Mailing Address - Zip Code:23920-3492
Mailing Address - Country:US
Mailing Address - Phone:909-213-1521
Mailing Address - Fax:
Practice Address - Street 1:1187 N MECKLENBURG AVE
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:VA
Practice Address - Zip Code:23950-1768
Practice Address - Country:US
Practice Address - Phone:434-447-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist