Healthcare Provider Details

I. General information

NPI: 1952723785
Provider Name (Legal Business Name): SANJAY PATEL PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 OLD CANOE CREEK RD
SAINT CLOUD FL
34769-1550
US

IV. Provider business mailing address

9037 HORIZON POINTE TRL
WINDERMERE FL
34786-8424
US

V. Phone/Fax

Practice location:
  • Phone: 407-892-7344
  • Fax:
Mailing address:
  • Phone: 949-466-9296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberPTA 23648
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTA23648
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: