MEDICARE: DHWANI SHAH

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	070.021969	IL
2	225100000X	Physical Therapist	25784	MD

General Provider Information

NPI Number	:	1760841803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DHWANI SHAH

Provider Business Mailing Address
First Line	:	570 VILLAGE CENTER DR STE 205
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-4526
Country	:	US
Telephone Number	:	309-204-6706
Fax Number	:

Provider Business Practice Location Address
First Line	:	1255 S STATE ST UNIT 6
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-1928
Country	:	US
Telephone Number	:	312-880-0808
Fax Number	:

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

Provider Enumeration Date	:	02/17/2016
Last Update Date	:	09/17/2024

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Directions to “ DHWANI SHAH ” Practice Location

Language	Start Address	Practice Location

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