Provider Demographics
NPI:1245748797
Name:SHASTRI, NIKITA (DPT)
Entity Type:Individual
Prefix:
First Name:NIKITA
Middle Name:
Last Name:SHASTRI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 RAINTREE CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5289
Mailing Address - Country:US
Mailing Address - Phone:972-727-9995
Mailing Address - Fax:972-727-8350
Practice Address - Street 1:1125 RAINTREE CIR STE 100100A
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4900
Practice Address - Country:US
Practice Address - Phone:714-732-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1298943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist