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General NPI Number Information
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NPI Number | 1629536776
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Entity Type | Individual
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Provider Name | MAYUR VISHNUBHAI PATEL PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 03/07/2019
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 1645 FOREST HILL RD STE 105
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City | MACON
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State | GA
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Zip | 31210-1697
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Country | US
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Telephone | 478-960-7077
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Fax | 478-245-9079
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Provider Business Mailing Address
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Address Line | 3708 NORTHSIDE DR
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City | MACON
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State | GA
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Zip | 31210-2404
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Country | US
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Telephone | 478-745-4206
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT014745
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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