Provider Demographics
NPI:1740618404
Name:PATEL, FORAMBEN ANKUR (MPT)
Entity Type:Individual
Prefix:MRS
First Name:FORAMBEN
Middle Name:ANKUR
Last Name:PATEL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 E POTOMAC LN
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-3151
Mailing Address - Country:US
Mailing Address - Phone:847-899-6641
Mailing Address - Fax:
Practice Address - Street 1:550 W FRONTAGE RD
Practice Address - Street 2:SUITE 2415
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-1202
Practice Address - Country:US
Practice Address - Phone:847-386-3022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist