Provider Demographics
NPI:1619083045
Name:PATEL, JAINA BHAGAT (DPT)
Entity Type:Individual
Prefix:DR
First Name:JAINA
Middle Name:BHAGAT
Last Name:PATEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:JAINA
Other - Middle Name:HASMUKH
Other - Last Name:BHAGAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6413 GWIN CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1254
Mailing Address - Country:US
Mailing Address - Phone:415-238-6470
Mailing Address - Fax:
Practice Address - Street 1:9545 RESEDA BLVD STE 4
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324
Practice Address - Country:US
Practice Address - Phone:818-886-2005
Practice Address - Fax:818-886-8165
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist