Provider Demographics
NPI:1609057322
Name:PATEL, LISA TALATI (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:TALATI
Last Name:PATEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 SURRYSE RD STE 250
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-3230
Mailing Address - Country:US
Mailing Address - Phone:847-842-4057
Mailing Address - Fax:847-842-4059
Practice Address - Street 1:450 W IL ROUTE 22
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-7509
Practice Address - Country:US
Practice Address - Phone:847-381-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.015869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist