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General NPI Number Information
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NPI Number | 1437910957
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Entity Type | Individual
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Provider Name | SHIV BHAKTA
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Gender | Male
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 1030 W WARNER AVE
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City | SANTA ANA
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State | CA
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Zip | 92707-3147
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Country | US
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Telephone | 714-546-6450
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Fax |
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone | 866-370-8206
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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 |
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License Number State |
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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 | PT304697
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License Number State | CA
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