Provider Demographics
NPI:1093774481
Name:YESHODHAN, SNEHDHAN (PT)
Entity Type:Individual
Prefix:
First Name:SNEHDHAN
Middle Name:
Last Name:YESHODHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6033 N SHERIDAN RD
Mailing Address - Street 2:APT 23-G
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3003
Mailing Address - Country:US
Mailing Address - Phone:773-769-6735
Mailing Address - Fax:773-769-6735
Practice Address - Street 1:6033 N SHERIDAN RD
Practice Address - Street 2:APT 23-G
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-3003
Practice Address - Country:US
Practice Address - Phone:773-769-6735
Practice Address - Fax:773-769-6735
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist