Healthcare Provider Details

I. General information

NPI: 1104377720
Provider Name (Legal Business Name): VAISHALI PATEL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 TIMBER DR E STE 102
GARNER NC
27529-5285
US

IV. Provider business mailing address

3911 N WASHINGTON ST
WILMINGTON DE
19802-2147
US

V. Phone/Fax

Practice location:
  • Phone: 919-500-5003
  • Fax:
Mailing address:
  • Phone: 302-764-8192
  • Fax: 302-764-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0003562
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number296098
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP21919
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: