Basic Information
| Provider Information | |||||||||
| NPI: | 1437662095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | ANKIT | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1510 CLAY AVE APT B | ||||||||
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| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324052652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506284314 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2316 W 23RD ST | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324052373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505224770 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2017 | ||||||||
| LastUpdateDate: | 11/06/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 33135 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.