Provider Demographics
NPI:1942897905
Name:PATEL, KESHA (PT)
Entity Type:Individual
Prefix:
First Name:KESHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 MOCCASIN TRL W
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8029
Mailing Address - Country:US
Mailing Address - Phone:646-706-6554
Mailing Address - Fax:
Practice Address - Street 1:333 GREENE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-2295
Practice Address - Country:US
Practice Address - Phone:347-396-3599
Practice Address - Fax:347-396-3153
Is Sole Proprietor?:No
Enumeration Date:2020-12-24
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046399225100000X
FLPT40027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist