Healthcare Provider Details

I. General information

NPI: 1588470314
Provider Name (Legal Business Name): SHAILEY DEDHIA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS SHAILEY DEDHIA

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 TERREL ST
LANTANA TX
76226-1946
US

IV. Provider business mailing address

9201 TERREL ST
LANTANA TX
76226-1946
US

V. Phone/Fax

Practice location:
  • Phone: 469-515-3844
  • Fax:
Mailing address:
  • Phone: 469-515-3844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1254476
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: