Provider Demographics
NPI:1821812835
Name:PATEL, VAIDIKA (DPT)
Entity type:Individual
Prefix:
First Name:VAIDIKA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-7527
Mailing Address - Country:US
Mailing Address - Phone:847-924-5691
Mailing Address - Fax:
Practice Address - Street 1:600 WAUKEGAN RD STE 132
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1249
Practice Address - Country:US
Practice Address - Phone:847-748-8733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.027763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist