Provider Demographics
NPI:1821291279
Name:PATEL, SAMIRKUMAR GOVINDBHAI (PHYSICALTHERAPIST)
Entity Type:Individual
Prefix:MR
First Name:SAMIRKUMAR
Middle Name:GOVINDBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHYSICALTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45629 UTICA GRN W
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5168
Mailing Address - Country:US
Mailing Address - Phone:586-212-5485
Mailing Address - Fax:
Practice Address - Street 1:45629 UTICA GRN W
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-5168
Practice Address - Country:US
Practice Address - Phone:586-212-5485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010124892251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics