Provider Demographics
NPI:1144641440
Name:PATEL, BHERUL
Entity type:Individual
Prefix:
First Name:BHERUL
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 MADISON AVE
Mailing Address - Street 2:APT D05
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-2586
Mailing Address - Country:US
Mailing Address - Phone:248-812-7191
Mailing Address - Fax:
Practice Address - Street 1:3060 MADISON AVE
Practice Address - Street 2:APT D05
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-2586
Practice Address - Country:US
Practice Address - Phone:248-812-7191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-04
Last Update Date:2014-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT40584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist