MEDICARE: MRS. NEELAM 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	PT012026	GA

General Provider Information

NPI Number	:	1346616570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NEELAM PATEL DPT

Provider Business Mailing Address
First Line	:	11190 MEDLOCK BRIDGE RD
Second Line	:
City	:	JOHNS CREEK
State	:	GA
Zip	:	30097-2578
Country	:	US
Telephone Number	:	678-691-6815
Fax Number	:	678-691-6918

Provider Business Practice Location Address
First Line	:	11190 MEDLOCK BRIDGE RD
Second Line	:
City	:	JOHNS CREEK
State	:	GA
Zip	:	30097-2578
Country	:	US
Telephone Number	:	678-691-6815
Fax Number	:	678-691-6918

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

Provider Enumeration Date	:	08/11/2015
Last Update Date	:	01/02/2017

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