1932177532 NPI number — INSTRIDE THERAPY, INC.

Table of content: DR. PRIYA KUNAL PATEL MD (NPI 1619437217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932177532 NPI number — INSTRIDE THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTRIDE THERAPY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932177532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1629 RANCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOKOMIS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-412-9333
Provider Business Mailing Address Fax Number:
941-483-3653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1621 RANCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOKOMIS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-412-9333
Provider Business Practice Location Address Fax Number:
941-483-3653
Provider Enumeration Date:
03/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JORGENSEN
Authorized Official First Name:
JODY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
941-412-9333

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 59-2198059 . This is a "BC/BS THERAPY SERVICES" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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