Healthcare Provider Details

I. General information

NPI: 1629536776
Provider Name (Legal Business Name): MAYUR VISHNUBHAI PATEL PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 FOREST HILL RD STE 105
MACON GA
31210-1697
US

IV. Provider business mailing address

3708 NORTHSIDE DR
MACON GA
31210-2404
US

V. Phone/Fax

Practice location:
  • Phone: 478-960-7077
  • Fax: 478-245-9079
Mailing address:
  • Phone: 478-745-4206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT014745
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: