Provider Demographics
NPI:1770029266
Name:PATEL, KRUTI JAYESH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KRUTI
Middle Name:JAYESH
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 1:3607 E WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7331
Mailing Address - Country:US
Mailing Address - Phone:602-430-1993
Mailing Address - Fax:
Practice Address - Street 1:3602 E GREENWAY RD STE 106
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4648
Practice Address - Country:US
Practice Address - Phone:602-715-2237
Practice Address - Fax:602-715-2238
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
AZ12730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist