Provider Demographics
NPI:1962678870
Name:PATEL, MANISH K (RPT)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40686 HARMON DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-1977
Mailing Address - Country:US
Mailing Address - Phone:248-980-1776
Mailing Address - Fax:586-314-0525
Practice Address - Street 1:40686 HARMON DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-1977
Practice Address - Country:US
Practice Address - Phone:248-980-1776
Practice Address - Fax:586-314-0525
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist