Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 07003879 | IL |
N | 2251G0304X | Physical Therapist - Geriatrics | 0703879 | IL |
NPI | 1205263167 |
---|---|
Provider Name | Mrs. Nutan H Shah |
First Address | Bartlett, IL 60103-5300 |
Second Address | Bartlett, IL 60103-5300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2013 |
Last Update Date | 08/10/2013 |