Provider Demographics
NPI:1346830163
Name:SHROFF, MAHIMA M
Entity Type:Individual
Prefix:
First Name:MAHIMA
Middle Name:M
Last Name:SHROFF
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 1:19530 HIGHLAND OAKS DR APT 208
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-9584
Mailing Address - Country:US
Mailing Address - Phone:412-726-2066
Mailing Address - Fax:
Practice Address - Street 1:3250 WINKLER AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9414
Practice Address - Country:US
Practice Address - Phone:412-726-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist