Provider Demographics
NPI:1689065385
Name:PATEL, CAROLYN MICHELLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MICHELLE
Last Name:PATEL
Suffix:
Gender:F
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 1:2402 NW 195TH PL
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2932
Mailing Address - Country:US
Mailing Address - Phone:206-364-3777
Mailing Address - Fax:206-364-3999
Practice Address - Street 1:2402 NW 195TH PL
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-2932
Practice Address - Country:US
Practice Address - Phone:206-364-3777
Practice Address - Fax:206-364-3999
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296502225100000X
WA60496388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist