MEDICARE: MRUGESHA SHAH MSPT

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	070021171	IL

General Provider Information

NPI Number	:	1609264993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRUGESHA SHAH MSPT

Provider Business Mailing Address
First Line	:	570 VILLAGE CENTER DR
Second Line	:	STE 205
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-4526
Country	:	US
Telephone Number	:	815-876-7063
Fax Number	:	630-920-4687

Provider Business Practice Location Address
First Line	:	2028 W OAKTON ST
Second Line	:	PARK RIDGE
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-1958
Country	:	US
Telephone Number	:	847-692-6964
Fax Number	:

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

Provider Enumeration Date	:	01/08/2015
Last Update Date	:	06/13/2022

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Directions to “ MRUGESHA SHAH MSPT” Practice Location

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