Provider Demographics
NPI:1174785018
Name:PATIL, SANJAY VASANTRAO (PT)
Entity type:Individual
Prefix:MR
First Name:SANJAY
Middle Name:VASANTRAO
Last Name:PATIL
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 1:9020 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3903
Mailing Address - Country:US
Mailing Address - Phone:951-688-8200
Mailing Address - Fax:951-688-1410
Practice Address - Street 1:9020 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3903
Practice Address - Country:US
Practice Address - Phone:951-688-8200
Practice Address - Fax:951-688-1410
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 20395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist