Healthcare Provider Details

I. General information

NPI: 1821291279
Provider Name (Legal Business Name): SAMIRKUMAR GOVINDBHAI PATEL PHYSICALTHERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45629 UTICA GRN W
SHELBY TOWNSHIP MI
48317-5168
US

IV. Provider business mailing address

45629 UTICA GRN W
SHELBY TOWNSHIP MI
48317-5168
US

V. Phone/Fax

Practice location:
  • Phone: 586-212-5485
  • Fax:
Mailing address:
  • Phone: 586-212-5485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number5501012489
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: