Provider Demographics
NPI:1124589304
Name:PARIKH, HETA BHAVESH
Entity Type:Individual
Prefix:
First Name:HETA
Middle Name:BHAVESH
Last Name:PARIKH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HETA
Other - Middle Name:NITINKUMAR
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3732 EDGEBROOK CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-6448
Mailing Address - Country:US
Mailing Address - Phone:732-960-1817
Mailing Address - Fax:
Practice Address - Street 1:3360 LACROSSE LN STE 110
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8165
Practice Address - Country:US
Practice Address - Phone:630-922-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.007832225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant