Healthcare Provider Details

I. General information

NPI: 1164366480
Provider Name (Legal Business Name): JAY PATEL PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3951 NORWICH DR
CANTON MI
48188-7232
US

IV. Provider business mailing address

3951 NORWICH DR
CANTON MI
48188-7232
US

V. Phone/Fax

Practice location:
  • Phone: 732-372-1159
  • Fax: 866-620-1406
Mailing address:
  • Phone: 732-372-1159
  • Fax: 866-620-1406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502005097
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: