MEDICARE: MS. SHIVANIBA JITENDRASINH GOHIL PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	053944	NY

General Provider Information

NPI Number	:	1063208601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHIVANIBA JITENDRASINH GOHIL PT

Provider Business Mailing Address
First Line	:	6805 FRESH POND RD
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-5200
Country	:	US
Telephone Number	:	718-456-2543
Fax Number	:

Provider Business Practice Location Address
First Line	:	1007 MANHATTAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11222-6626
Country	:	US
Telephone Number	:	718-383-7361
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2025
Last Update Date	:	04/18/2025

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