Provider Demographics
NPI:1134455785
Name:PATEL, DIPA B (RPT)
Entity type:Individual
Prefix:MS
First Name:DIPA
Middle Name:B
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 W US HIGHWAY 10
Mailing Address - Street 2:SUITE # B
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2455
Mailing Address - Country:US
Mailing Address - Phone:989-772-7755
Mailing Address - Fax:989-772-7750
Practice Address - Street 1:5511 W US HIGHWAY 10
Practice Address - Street 2:SUITE # B
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2455
Practice Address - Country:US
Practice Address - Phone:989-772-7755
Practice Address - Fax:989-772-7750
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2011-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501014412OtherSTATE OF MICHIGAN