Provider Demographics
NPI:1588387856
Name:PATEL, MAYANKKUMAR
Entity type:Individual
Prefix:
First Name:MAYANKKUMAR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5114 ADEGA WAY
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-2817
Mailing Address - Country:US
Mailing Address - Phone:845-903-2312
Mailing Address - Fax:941-263-8074
Practice Address - Street 1:5114 ADEGA WAY
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-2817
Practice Address - Country:US
Practice Address - Phone:845-903-2312
Practice Address - Fax:877-407-4329
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT39716225100000X
NY047421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist