Provider Demographics
NPI:1659662690
Name:PATEL, KUNAL (MPT)
Entity Type:Individual
Prefix:MR
First Name:KUNAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 WALNUT AVE
Mailing Address - Street 2:APT 303B
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2290
Mailing Address - Country:US
Mailing Address - Phone:510-742-9580
Mailing Address - Fax:510-742-9580
Practice Address - Street 1:3800 WALNUT AVE
Practice Address - Street 2:APT 303B
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2290
Practice Address - Country:US
Practice Address - Phone:510-742-9580
Practice Address - Fax:510-742-9580
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4288Medicare PIN