Provider Demographics
NPI:1093905416
Name:GARUD, MEDHA MADHUKAR (PT)
Entity Type:Individual
Prefix:
First Name:MEDHA
Middle Name:MADHUKAR
Last Name:GARUD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:973 PACIFIC AVE
Mailing Address - Street 2:APT # B
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-6216
Mailing Address - Country:US
Mailing Address - Phone:630-664-1771
Mailing Address - Fax:
Practice Address - Street 1:1641 S ROSELLE ROAD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193
Practice Address - Country:US
Practice Address - Phone:630-664-1771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.008033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist