Provider Demographics
NPI:1952896904
Name:PATEL, SONAL P (PTA)
Entity Type:Individual
Prefix:
First Name:SONAL
Middle Name:P
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 1:4790 PEACHTREE INDUSTRIAL BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-5723
Mailing Address - Country:US
Mailing Address - Phone:678-718-5240
Mailing Address - Fax:844-860-3356
Practice Address - Street 1:4709 PEACHTREE IND BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071
Practice Address - Country:US
Practice Address - Phone:405-202-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003103225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty