Provider Demographics
NPI:1013100494
Name:PATEL, VINAY BHANUBHAI (PTA)
Entity Type:Individual
Prefix:MR
First Name:VINAY
Middle Name:BHANUBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 SWIFT BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-5366
Mailing Address - Country:US
Mailing Address - Phone:804-536-4412
Mailing Address - Fax:
Practice Address - Street 1:2305 SWIFT BLUFF DR
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-5366
Practice Address - Country:US
Practice Address - Phone:804-536-4412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006669225200000X
VA2306602356225200000X
MI225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant