Healthcare Provider Details

I. General information

NPI: 1760830780
Provider Name (Legal Business Name): KUNAL PATEL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 WALNUT AVE APT 303B
FREMONT CA
94538-2275
US

IV. Provider business mailing address

3800 WALNUT AVE APT 303B
FREMONT CA
94538-2275
US

V. Phone/Fax

Practice location:
  • Phone: 510-714-4288
  • Fax:
Mailing address:
  • Phone: 510-714-4288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT37768
License Number StateCA

VIII. Authorized Official

Name: MR. KUNAL PATEL
Title or Position: CEO
Credential: MPT
Phone: 510-714-4288