Provider Demographics
NPI:1154855286
Name:SHIVANI, RAKHI BHAGWANDAS (PT)
Entity Type:Individual
Prefix:
First Name:RAKHI
Middle Name:BHAGWANDAS
Last Name:SHIVANI
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 1:1023 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2450
Mailing Address - Country:US
Mailing Address - Phone:615-624-8476
Mailing Address - Fax:615-624-8478
Practice Address - Street 1:1023 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2450
Practice Address - Country:US
Practice Address - Phone:615-624-8476
Practice Address - Fax:615-624-8478
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCP003579T225100000X
MD26478225100000X
TX12651282251X0800X
TN13270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN13270OtherTENNESSEE STATE PHYSICAL THERAPY LICENSE