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General NPI Number Information
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NPI Number | 1144510090
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Entity Type | Individual
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Provider Name | PIYUSH PARSHOTTAMBHAI PATEL RPT
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Gender | Male
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 997 S LAKESHORE DR
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City | LAKE CITY
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State | MI
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Zip | 49651-8750
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Country | US
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Telephone | 231-839-8888
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Fax | 231-894-8158
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Provider Business Mailing Address
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Address Line | 555 S MISSION ST
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City | MOUNT PLEASANT
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State | MI
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Zip | 48858-2846
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Country | US
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Telephone | 989-772-7755
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Fax | 989-772-7750
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501015278
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License Number State | MI
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