Provider Demographics
NPI:1760999825
Name:PATEL, SHREERAJ MUKESH (DPT)
Entity Type:Individual
Prefix:
First Name:SHREERAJ
Middle Name:MUKESH
Last Name:PATEL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:RAJ
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:
Practice Address - Street 1:19101 LIMESTONE COMMERCIAL DR STE 200
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-4511
Practice Address - Country:US
Practice Address - Phone:615-373-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018503225100000X
TX1341627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist