Provider Demographics
NPI:1861699035
Name:PATEL, SWATI M (DPT)
Entity type:Individual
Prefix:
First Name:SWATI
Middle Name:M
Last Name:PATEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NEWPORT CENTER DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3921
Mailing Address - Country:US
Mailing Address - Phone:310-940-4779
Mailing Address - Fax:
Practice Address - Street 1:471 W LAMBERT RD
Practice Address - Street 2:STE 106
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3921
Practice Address - Country:US
Practice Address - Phone:714-255-8877
Practice Address - Fax:714-255-8878
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR729ZMedicare PIN