Provider Demographics
NPI:1821423468
Name:PATEL, BHAUMIK J
Entity Type:Individual
Prefix:
First Name:BHAUMIK
Middle Name:J
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3928 BURBERRY DR S
Mailing Address - Street 2:APT 194
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-6577
Mailing Address - Country:US
Mailing Address - Phone:765-418-3515
Mailing Address - Fax:
Practice Address - Street 1:3401 SOLDIERS HOME RD
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1222
Practice Address - Country:US
Practice Address - Phone:765-463-1541
Practice Address - Fax:765-497-0687
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010187A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist