MEDICARE: DIPTI MUKESH ARYA PATEL P.T.

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	5501005237	MI

General Provider Information

NPI Number	:	1780905687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIPTI MUKESH ARYA PATEL P.T.

Provider Business Mailing Address
First Line	:	45424 GLENGARRY BLVD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-3001
Country	:	US
Telephone Number	:	313-549-2722
Fax Number	:	734-844-3030

Provider Business Practice Location Address
First Line	:	45424 GLENGARRY BLVD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-3001
Country	:	US
Telephone Number	:	313-549-2722
Fax Number	:	734-844-3030

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

Provider Enumeration Date	:	06/15/2010
Last Update Date	:	06/15/2010

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