Healthcare Provider Details

I. General information

NPI: 1639887797
Provider Name (Legal Business Name): KUSHAL PATEL PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 S APOLLO BLVD UNIT 101
MELBOURNE FL
32901-3146
US

IV. Provider business mailing address

1305 S APOLLO BLVD UNIT 101
MELBOURNE FL
32901-3146
US

V. Phone/Fax

Practice location:
  • Phone: 321-372-1055
  • Fax:
Mailing address:
  • Phone: 321-372-1055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT43119
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: