Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 05009765A | IN |
N | 2251G0304X | Physical Therapist - Geriatrics | 05009765A | IN |
NPI | 1114237054 |
---|---|
Provider Name | Ms. Shefali Suresh Gandhi |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Munster, IN 46321-1528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2010 |
Last Update Date | 10/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201055610 | (05) | IN |
P01061953 | MEDICARE RAILROAD (01) | IN |