Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 10002 | NC |
N | 2251P0200X | Physical Therapist - Pediatrics | 10002 | NC |
NPI | 1083750608 |
---|---|
Provider Name | Kunjal Patel |
First Address | Indian Trail, NC 28079-7691 |
Second Address | Indian Trail, NC 28079-7691 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 02/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7211704 | (05) | NC |