Healthcare Provider Details

I. General information

NPI: 1831681097
Provider Name (Legal Business Name): JIGAR V PATEL PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13385 W MCDOWELL RD
GOODYEAR AZ
85395
US

IV. Provider business mailing address

16395 W LILAC ST
GOODYEAR AZ
85338-2568
US

V. Phone/Fax

Practice location:
  • Phone: 623-986-5110
  • Fax:
Mailing address:
  • Phone: 630-217-8927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-011924
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: