Healthcare Provider Details

I. General information

NPI: 1366461717
Provider Name (Legal Business Name): RAKESHKUMAR PATEL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/18/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 LASALLE AVE
BRONX NY
10461-6021
US

IV. Provider business mailing address

3019 LASALLE AVE
BRONX NY
10461-6021
US

V. Phone/Fax

Practice location:
  • Phone: 347-419-3233
  • Fax:
Mailing address:
  • Phone: 347-419-3233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number028089
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number028089
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: