Healthcare Provider Details

I. General information

NPI: 1801121280
Provider Name (Legal Business Name): MR. SHUBHANSHU SAXENA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 10/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 COLLEGE AVE
GOSHEN IN
46528-5010
US

IV. Provider business mailing address

1800 N WABASH RD SUITE 200
MARION IN
46952-1300
US

V. Phone/Fax

Practice location:
  • Phone: 574-533-0351
  • Fax:
Mailing address:
  • Phone: 765-651-3229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05009793A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: