Provider Demographics
NPI:1093001257
Name:THAKKAR, NITUL (PTA)
Entity Type:Individual
Prefix:MR
First Name:NITUL
Middle Name:
Last Name:THAKKAR
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 HUMMINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-3354
Mailing Address - Country:US
Mailing Address - Phone:847-322-6601
Mailing Address - Fax:
Practice Address - Street 1:56 HUMMINGBIRD LN
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-3354
Practice Address - Country:US
Practice Address - Phone:847-322-6601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9369225200000X
IL160004487225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant