Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 037684 | NY |
N | 225100000X | Physical Therapist | 05011595A | IN |
Y | 225100000X | Physical Therapist | 070021152 | IL |
NPI | 1003205493 |
---|---|
Provider Name | Pooja Shah |
First Address | Des Plaines, IL 60018-1478 |
Second Address | Des Plaines, IL 60018-1478 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2015 |
Last Update Date | 22/01/2015 |