Provider Demographics
NPI:1144510090
Name:PATEL, PIYUSH PARSHOTTAMBHAI (RPT)
Entity type:Individual
Prefix:MR
First Name:PIYUSH
Middle Name:PARSHOTTAMBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S MISSION ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2846
Mailing Address - Country:US
Mailing Address - Phone:989-772-7755
Mailing Address - Fax:989-772-7750
Practice Address - Street 1:997 S LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MI
Practice Address - Zip Code:49651-8750
Practice Address - Country:US
Practice Address - Phone:231-839-8888
Practice Address - Fax:231-894-8158
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501015278OtherSTATE OF MI