Provider Demographics
NPI:1861987356
Name:PATEL, GUNJAN D (PT)
Entity type:Individual
Prefix:
First Name:GUNJAN
Middle Name:D
Last Name:PATEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5457 S ASHCROFT WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6866
Mailing Address - Country:US
Mailing Address - Phone:208-703-4950
Mailing Address - Fax:
Practice Address - Street 1:3645 E OVERLAND RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6751
Practice Address - Country:US
Practice Address - Phone:208-593-5252
Practice Address - Fax:208-593-5251
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2023-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT5798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist