Provider Demographics
NPI:1114598836
Name:THAKKAR, VRUNDA
Entity Type:Individual
Prefix:
First Name:VRUNDA
Middle Name:
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 E CHRISTINA CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-5026
Mailing Address - Country:US
Mailing Address - Phone:847-907-0755
Mailing Address - Fax:
Practice Address - Street 1:1317 E CHRISTINA CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-5026
Practice Address - Country:US
Practice Address - Phone:847-907-0755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-03
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.009074225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant