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General NPI Number Information
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NPI Number | 1306324132
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Entity Type | Individual
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Provider Name | MAITRI SHUKLA PT
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Gender | Female
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 710 LAWRENCE EXPY # 174
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City | SANTA CLARA
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State | CA
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Zip | 95051-5173
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Country | US
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Telephone | 408-851-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 1729 N 1ST ST APT 20701
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City | SAN JOSE
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State | CA
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Zip | 95112-4634
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Country | US
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Telephone | 847-414-9155
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.023708
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 302192
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License Number State | CA
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