MEDICARE: JAY 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	5502005097	MI

General Provider Information

NPI Number	:	1164366480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY PATEL PTA

Provider Business Mailing Address
First Line	:	3951 NORWICH DR
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-7232
Country	:	US
Telephone Number	:	732-372-1159
Fax Number	:	866-620-1406

Provider Business Practice Location Address
First Line	:	3951 NORWICH DR
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-7232
Country	:	US
Telephone Number	:	732-372-1159
Fax Number	:	866-620-1406

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

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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Directions to “ JAY PATEL PTA” Practice Location

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