Provider Demographics
NPI:1932842408
Name:PATEL, MANISHABEN D (PTA)
Entity Type:Individual
Prefix:
First Name:MANISHABEN
Middle Name:D
Last Name:PATEL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 W 180TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4802
Mailing Address - Country:US
Mailing Address - Phone:646-918-7816
Mailing Address - Fax:646-661-2151
Practice Address - Street 1:651 W 180TH ST STE 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4802
Practice Address - Country:US
Practice Address - Phone:646-918-7816
Practice Address - Fax:646-661-2151
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008248225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant