=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811266489
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HIRAL KANADA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2011
-----------------------------------------------------
Last Update Date | 12/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3705 DEERFIELD RD
-----------------------------------------------------
City | RIVERWOODS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60015-3540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-947-9000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 BAYSIDE DR UNIT 2
-----------------------------------------------------
City | PALATINE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60074-3281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-939-9436
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 160005415
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------