Provider Demographics
NPI:1639400526
Name:PATEL, YAKUB ISAP (DPT)
Entity Type:Individual
Prefix:MR
First Name:YAKUB
Middle Name:ISAP
Last Name:PATEL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15868 S LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4702
Mailing Address - Country:US
Mailing Address - Phone:708-612-5992
Mailing Address - Fax:708-633-7223
Practice Address - Street 1:15868 S LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4702
Practice Address - Country:US
Practice Address - Phone:708-612-5992
Practice Address - Fax:708-633-7223
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-17
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.003982225100000X
IN05007035A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist