Provider Demographics
NPI:1841778446
Name:PATEL, SHIVANI MINISH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SHIVANI
Middle Name:MINISH
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 1:512 CALDERA CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-9486
Mailing Address - Country:US
Mailing Address - Phone:443-974-2094
Mailing Address - Fax:
Practice Address - Street 1:512 CALDERA CT
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21158-9486
Practice Address - Country:US
Practice Address - Phone:443-974-2094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist