Healthcare Provider Details

I. General information

NPI: 1164729695
Provider Name (Legal Business Name): VISHAL VRAJLAL PATEL R.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27423 VAN DYKE AVE
WARREN MI
48093-2867
US

IV. Provider business mailing address

27423 VAN DYKE AVE
WARREN MI
48093-2867
US

V. Phone/Fax

Practice location:
  • Phone: 586-757-4000
  • Fax: 586-755-9880
Mailing address:
  • Phone: 586-757-4000
  • Fax: 586-755-9880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501015079
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: