MEDICARE: MITALI A PATEL DPT

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	225100000X	Physical Therapist	13283-24	WI

General Provider Information

NPI Number	:	1104286723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITALI A PATEL DPT

Provider Business Mailing Address
First Line	:	1300 S GREEN BAY RD
Second Line	:	SUITE #205
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-4469
Country	:	US
Telephone Number	:	262-898-3930
Fax Number	:	262-898-3933

Provider Business Practice Location Address
First Line	:	1300 S GREEN BAY RD
Second Line	:	SUITE #205
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-4469
Country	:	US
Telephone Number	:	262-898-3930
Fax Number	:	262-898-3933

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

Provider Enumeration Date	:	02/24/2016
Last Update Date	:	02/24/2016

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