Provider Demographics
NPI:1295066884
Name:PATARIA, BRIJPAL SINGH (DPT)
Entity type:Individual
Prefix:DR
First Name:BRIJPAL
Middle Name:SINGH
Last Name:PATARIA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 SAN MARCO DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-3503
Mailing Address - Country:US
Mailing Address - Phone:209-251-2425
Mailing Address - Fax:
Practice Address - Street 1:4339 E MORADA LN STE 150
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-1634
Practice Address - Country:US
Practice Address - Phone:209-888-6346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist