Provider Demographics
NPI:1932580149
Name:PATEL, BHOOMI MUKESHKUMAR (PT)
Entity Type:Individual
Prefix:
First Name:BHOOMI
Middle Name:MUKESHKUMAR
Last Name:PATEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BHOOMI
Other - Middle Name:MUKESH
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3250 S ARIZONA AVE
Mailing Address - Street 2:APT 2019
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-2705
Mailing Address - Country:US
Mailing Address - Phone:857-203-1671
Mailing Address - Fax:
Practice Address - Street 1:3250 S ARIZONA AVE
Practice Address - Street 2:APT 2019
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-2705
Practice Address - Country:US
Practice Address - Phone:857-203-1671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ11444OtherARIZONA BOARD OF PT