1720178767 NPI number — MONA PATEL KAPADIA DPT, MSPT

Table of content: MONA PATEL KAPADIA DPT, MSPT (NPI 1720178767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720178767 NPI number — MONA PATEL KAPADIA DPT, MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAPADIA
Provider First Name:
MONA
Provider Middle Name:
PATEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT, MSPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PATEL
Provider Other First Name:
MONA
Provider Other Middle Name:
RAJANIKANT
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT, MSPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720178767
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13020 N TELECOM PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPLE TERRACE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33637-0925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-978-9700
Provider Business Mailing Address Fax Number:
813-588-6186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13020 N TELECOM PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE TERRACE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33637-0925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-978-9700
Provider Business Practice Location Address Fax Number:
813-558-6186
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  007928 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 24939 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X , with the licence number: PT30512 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 15302 . This is a "ORTHO NET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 080007928CT01 . This is a "BLUE CARE FAMIL PLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 080007928CT01 . This is a "BCBS ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004264660 . This is a "GHMC GROUP MEDICAID PROVI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 370458 . This is a "WELLCARE MEDICARE ONLY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1470171 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004264678 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1255448155 . This is a "GHMC GROUP NPI ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V9101 . This is a "HEALTH NET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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