Provider Demographics
NPI:1720747694
Name:PATEL, KALPESH RANCHHODBHAI (PT)
Entity Type:Individual
Prefix:
First Name:KALPESH
Middle Name:RANCHHODBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42326 CARRIAGE COVE DR APT 2-104
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3543
Mailing Address - Country:US
Mailing Address - Phone:704-756-5080
Mailing Address - Fax:
Practice Address - Street 1:42326 CARRIAGE COVE DR APT 2-104
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3543
Practice Address - Country:US
Practice Address - Phone:704-756-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501021598225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist