Healthcare Provider Details

I. General information

NPI: 1942426499
Provider Name (Legal Business Name): PRITI PATEL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7811 MAPLE AVE
PENNSAUKEN NJ
08109-3395
US

IV. Provider business mailing address

21 FOXCROFT WAY
MOUNT LAUREL NJ
08054-5733
US

V. Phone/Fax

Practice location:
  • Phone: 856-488-1212
  • Fax:
Mailing address:
  • Phone: 856-439-6352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00904600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: