Provider Demographics
NPI:1861853368
Name:PATEL, PAURISH (PT)
Entity Type:Individual
Prefix:
First Name:PAURISH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 288
Mailing Address - Street 2:REHAB SOLUTION
Mailing Address - City:LYONS
Mailing Address - State:IL
Mailing Address - Zip Code:60534-0288
Mailing Address - Country:US
Mailing Address - Phone:708-447-9616
Mailing Address - Fax:708-447-9626
Practice Address - Street 1:7310 39TH ST
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:IL
Practice Address - Zip Code:60534-1247
Practice Address - Country:US
Practice Address - Phone:708-447-9616
Practice Address - Fax:708-447-9626
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.022910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist