Healthcare Provider Details

I. General information

NPI: 1730737909
Provider Name (Legal Business Name): ROMISHABEN A PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 W EXECUTIVE DR STE 500
ADDISON IL
60101-5626
US

IV. Provider business mailing address

9268 BARBERRY LN
DES PLAINES IL
60016-4207
US

V. Phone/Fax

Practice location:
  • Phone: 630-766-0505
  • Fax: 630-766-6465
Mailing address:
  • Phone: 224-715-2416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160008144
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: