Provider Demographics
NPI:1174773162
Name:PATEL, NAINESHKUMAR JAYANTILAL (PT)
Entity type:Individual
Prefix:
First Name:NAINESHKUMAR
Middle Name:JAYANTILAL
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 1:1026 ALBEE FARM RD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-6213
Mailing Address - Country:US
Mailing Address - Phone:941-284-7106
Mailing Address - Fax:
Practice Address - Street 1:1026 ALBEE FARM RD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-6213
Practice Address - Country:US
Practice Address - Phone:941-284-7106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030564225100000X
FLPT 27814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400006604Medicare PIN
NYA400009571Medicare PIN
NYA400009570Medicare PIN
NYA400009569Medicare PIN
NYG400001008Medicare PIN