Provider Demographics
NPI:1629492665
Name:PATEL, NIRALIBEN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:NIRALIBEN
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W GRAND BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2353
Mailing Address - Country:US
Mailing Address - Phone:313-554-3600
Mailing Address - Fax:313-554-3601
Practice Address - Street 1:901 W GRAND BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2353
Practice Address - Country:US
Practice Address - Phone:313-554-3600
Practice Address - Fax:313-554-3601
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist