Healthcare Provider Details

I. General information

NPI: 1376261750
Provider Name (Legal Business Name): SHVETA KOTHARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WYNDEMERE CIR
WHEATON IL
60187-2424
US

IV. Provider business mailing address

581 STUART DR
CAROL STREAM IL
60188-4410
US

V. Phone/Fax

Practice location:
  • Phone: 630-690-6662
  • Fax:
Mailing address:
  • Phone: 630-550-1496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: