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General NPI Number Information
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NPI Number | 1447950886
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Entity Type | Individual
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Provider Name | JAIMINI MAYANK PATEL
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Gender | Female
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 1000 SUNSET RIDGE RD
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City | NORTHBROOK
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State | IL
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Zip | 60062-4008
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Country | US
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Telephone | 224-235-4639
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Fax |
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Provider Business Mailing Address
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Address Line | 7937 LYONS ST
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City | MORTON GROVE
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State | IL
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Zip | 60053-1636
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Country | US
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Telephone | 847-858-6186
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160.005052
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License Number State | IL
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