Provider Demographics
NPI:1528606027
Name:PATEL, KINJAL (PT)
Entity Type:Individual
Prefix:
First Name:KINJAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W MAIN ST #3
Mailing Address - Street 2:
Mailing Address - City:NORTH BOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532
Mailing Address - Country:US
Mailing Address - Phone:508-393-9000
Mailing Address - Fax:508-393-9525
Practice Address - Street 1:411 W MAIN ST #3
Practice Address - Street 2:
Practice Address - City:NORTH BOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532
Practice Address - Country:US
Practice Address - Phone:508-393-9000
Practice Address - Fax:508-393-9525
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21624225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist