Provider Demographics
NPI:1972777506
Name:PATEL, KRISHNA S (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:KRISHNA
Middle Name:S
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7023 FOX CREEK DR.
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3511
Mailing Address - Country:US
Mailing Address - Phone:734-844-7524
Mailing Address - Fax:
Practice Address - Street 1:7023 FOXCREEK DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3581
Practice Address - Country:US
Practice Address - Phone:734-844-7524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M90600Medicare PIN