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NPI Code Detail

MEDICARE: NICKY PATEL MPT

MEDICARE: NICKY PATEL MPT
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
1225100000XPhysical Therapist23072FL

General Provider Information

NPI Number : 1043401714
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICKY PATEL MPT
Provider Business Mailing Address
First Line : 23013 WESTCHESTER BLVD
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33980-8448
Country : US
Telephone Number : 941-235-2327
Fax Number :
Provider Business Practice Location Address
First Line : 23013 WESTCHESTER BLVD
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33980-8448
Country : US
Telephone Number : 941-235-2327
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2007
Last Update Date : 08/07/2007

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