Provider Demographics
NPI:1609199728
Name:PATEL, MITAL MEHUL (PT)
Entity Type:Individual
Prefix:MRS
First Name:MITAL
Middle Name:MEHUL
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 1:4 CHESTER AVE
Mailing Address - Street 2:APT#4
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3880
Mailing Address - Country:US
Mailing Address - Phone:513-378-4639
Mailing Address - Fax:
Practice Address - Street 1:2432 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2503
Practice Address - Country:US
Practice Address - Phone:860-236-3557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist