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General NPI Number Information
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NPI Number | 1821812835
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Entity Type | Individual
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Provider Name | VAIDIKA PATEL DPT
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Gender | Female
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 600 WAUKEGAN RD STE 132
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City | NORTHBROOK
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State | IL
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Zip | 60062-1249
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Country | US
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Telephone | 847-748-8733
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Fax |
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Provider Business Mailing Address
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Address Line | 608 N 3RD AVE
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City | DES PLAINES
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State | IL
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Zip | 60016-7527
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Country | US
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Telephone | 847-924-5691
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.027763
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License Number State | IL
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