Provider Demographics
NPI:1629536776
Name:PATEL, MAYUR VISHNUBHAI (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MAYUR
Middle Name:VISHNUBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2404
Mailing Address - Country:US
Mailing Address - Phone:478-745-4206
Mailing Address - Fax:
Practice Address - Street 1:1645 FOREST HILL RD STE 105
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1697
Practice Address - Country:US
Practice Address - Phone:478-960-7077
Practice Address - Fax:478-245-9079
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251X0800X, 261QP2000X
GAPT0147452251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty