MEDICARE: MR. VINAY BHANUBHAI PATEL PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	006669	NY
2	225200000X	Physical Therapy Assistant	2306602356	VA
3	225200000X	Physical Therapy Assistant		MI

General Provider Information

NPI Number	:	1013100494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VINAY BHANUBHAI PATEL PTA

Provider Business Mailing Address
First Line	:	2305 SWIFT BLUFF DR
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-5366
Country	:	US
Telephone Number	:	804-536-4412
Fax Number	:

Provider Business Practice Location Address
First Line	:	2305 SWIFT BLUFF DR
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-5366
Country	:	US
Telephone Number	:	804-536-4412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2007
Last Update Date	:	08/17/2010

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