MEDICARE: MISS KOSHA J PATEL

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	5501012481	MI

General Provider Information

NPI Number	:	1639193139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KOSHA J PATEL

Provider Business Mailing Address
First Line	:	34278 LENNOX CT
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94555-2132
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	39210 STATE ST
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94538-1456
Country	:	US
Telephone Number	:	105-790-9480
Fax Number	:

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	08/02/2022

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Directions to “ MISS KOSHA J PATEL ” Practice Location

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