Provider Demographics
NPI:1497362784
Name:PATEL, RITESHKUMAR KANTILAL (RPT)
Entity Type:Individual
Prefix:
First Name:RITESHKUMAR
Middle Name:KANTILAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44004 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5031
Mailing Address - Country:US
Mailing Address - Phone:248-550-4819
Mailing Address - Fax:248-232-2784
Practice Address - Street 1:44004 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5031
Practice Address - Country:US
Practice Address - Phone:248-550-4819
Practice Address - Fax:248-232-2784
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014315225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501014315OtherPHYSICAL THERAPY LICENSE