Healthcare Provider Details

I. General information

NPI: 1154330223
Provider Name (Legal Business Name): GITA PATEL OGLETREE PA-C, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 HOSPITAL DR STE 202
FAIRHOPE AL
36532-2038
US

IV. Provider business mailing address

188 HOSPITAL DR STE 202
FAIRHOPE AL
36532-2038
US

V. Phone/Fax

Practice location:
  • Phone: 251-990-1922
  • Fax: 251-990-1912
Mailing address:
  • Phone: 251-990-1922
  • Fax: 251-990-1912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.926
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: