Provider Demographics
NPI:1649818378
Name:PATEL, KUNAL (PT297769)
Entity Type:Individual
Prefix:
First Name:KUNAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PT297769
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 N 1ST ST APT 311
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-2482
Mailing Address - Country:US
Mailing Address - Phone:408-866-5567
Mailing Address - Fax:408-866-1317
Practice Address - Street 1:163 E HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0234
Practice Address - Country:US
Practice Address - Phone:408-866-5567
Practice Address - Fax:408-866-1317
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT1297769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist