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General NPI Number Information
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NPI Number | 1487347076
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Entity Type | Individual
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Provider Name | SANJIV DHODAPKAR PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 140 N ADDISON AVE
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City | ELMHURST
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State | IL
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Zip | 60126-2810
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Country | US
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Telephone | 630-882-0140
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Fax |
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Provider Business Mailing Address
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Address Line | 100 FOREST PL APT 1307
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City | OAK PARK
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State | IL
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Zip | 60301-1141
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Country | US
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Telephone |
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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 | 070.027505
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License Number State | IL
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