Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070.01425 | IL |
NPI | 1003000555 |
---|---|
Provider Name | Mrs. Manisha Ajit Patel |
First Address | Rockford, IL 61104-2315 |
Second Address | Rockford, IL 61104-2315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 28/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070.01425 | STATE OF ILLINOIS (01) |