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General NPI Number Information
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NPI Number | 1700178662
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Entity Type | Individual
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Provider Name | JAYSHREE J PATEL PTA
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Gender | Female
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Dates
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Enumeration Date | 05/11/2011
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Last Update Date | 05/11/2011
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Provider Practice Location Address
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Address Line | 617 N STATE ST
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City | CLARKSDALE
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State | MS
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Zip | 38614-6517
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Country | US
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Telephone | 662-247-1254
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Fax |
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Provider Business Mailing Address
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Address Line | 640 WINTERGREEN ST
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City | GREENVILLE
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State | MS
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Zip | 38701-7552
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Country | US
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Telephone | 803-883-1247
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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 | 4641
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License Number State | MS
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