MEDICARE: MRS. MAMTA N PATEL PT,LMBT

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	2145	NC
2	225700000X	Massage Therapist	2182	NC

General Provider Information

NPI Number	:	1972770345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAMTA N PATEL PT,LMBT

Provider Business Mailing Address
First Line	:	5113 PIPER STATION DR
Second Line	:	SUITE 300
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-6689
Country	:	US
Telephone Number	:	704-965-4307
Fax Number	:

Provider Business Practice Location Address
First Line	:	5113 PIPER STATION DR
Second Line	:	SUITE 300
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-6689
Country	:	US
Telephone Number	:	704-965-4307
Fax Number	:

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

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/14/2008

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