Provider Demographics
NPI:1538491691
Name:PATEL, PRATIK R (PT)
Entity Type:Individual
Prefix:MR
First Name:PRATIK
Middle Name:R
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 1:29688 TELEGRAPH RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1362
Mailing Address - Country:US
Mailing Address - Phone:248-223-9890
Mailing Address - Fax:248-223-9891
Practice Address - Street 1:29688 TELEGRAPH RD
Practice Address - Street 2:SUITE 600
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1362
Practice Address - Country:US
Practice Address - Phone:248-223-9890
Practice Address - Fax:248-223-9891
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014845225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist