MEDICARE: MRS. TEJAL R. 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	160004847	IL

General Provider Information

NPI Number	:	1598036378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TEJAL R. PATEL PTA

Provider Business Mailing Address
First Line	:	43 E JUDITH ANN DR
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-2106
Country	:	US
Telephone Number	:	847-445-2071
Fax Number	:

Provider Business Practice Location Address
First Line	:	43 JUDITH ANN DR.
Second Line	:
City	:	MT. PROSPECT
State	:	IL
Zip	:	60056-2106
Country	:	US
Telephone Number	:	847-445-2071
Fax Number	:

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

Provider Enumeration Date	:	01/25/2012
Last Update Date	:	01/25/2012

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