Provider Demographics
NPI:1790242287
Name:PATEL, RACHANA R (RPT)
Entity Type:Individual
Prefix:
First Name:RACHANA
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12830 FORD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3350
Mailing Address - Country:US
Mailing Address - Phone:313-406-3832
Mailing Address - Fax:313-406-3716
Practice Address - Street 1:12830 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3350
Practice Address - Country:US
Practice Address - Phone:313-406-3832
Practice Address - Fax:313-406-3716
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist