Provider Demographics
NPI:1568914182
Name:PATEL, DISHA
Entity Type:Individual
Prefix:
First Name:DISHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 KNIGHTS RD
Mailing Address - Street 2:APT#9306
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-3410
Mailing Address - Country:US
Mailing Address - Phone:215-290-7542
Mailing Address - Fax:
Practice Address - Street 1:2500 KNIGHTS RD
Practice Address - Street 2:APT#9306
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3410
Practice Address - Country:US
Practice Address - Phone:215-290-7542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038716225100000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility