Healthcare Provider Details

I. General information

NPI: 1164336863
Provider Name (Legal Business Name): MANA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 BRICK RD
MARLTON NJ
08053-2177
US

IV. Provider business mailing address

24 MERYL LN
CHERRY HILL NJ
08002-1550
US

V. Phone/Fax

Practice location:
  • Phone: 856-988-8778
  • Fax:
Mailing address:
  • Phone: 856-745-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02453100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: