MEDICARE: KUNTAL PATEL DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	20931	MD
2	225100000X	Physical Therapist	070.14580	IL

General Provider Information

NPI Number	:	1295084796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KUNTAL PATEL DPT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2222
Fax Number	:	630-759-9510

Provider Business Practice Location Address
First Line	:	9512 HARFORD RD STE 3
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21234-3127
Country	:	US
Telephone Number	:	410-882-3010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	06/03/2021

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Directions to “ KUNTAL PATEL DPT” Practice Location

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