Provider Demographics
NPI:1043617392
Name:LODHIA, SHANTILAL (CMLDT, LMBT)
Entity Type:Individual
Prefix:MR
First Name:SHANTILAL
Middle Name:
Last Name:LODHIA
Suffix:
Gender:M
Credentials:CMLDT, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 TRAILVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513
Mailing Address - Country:US
Mailing Address - Phone:919-274-3403
Mailing Address - Fax:
Practice Address - Street 1:203 N HARRISON AVE STE 206
Practice Address - Street 2:206
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-4558
Practice Address - Country:US
Practice Address - Phone:919-228-9559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLMBT #11844225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist