Provider Demographics
NPI:1467761056
Name:SHAH, SHALVI RUTUL
Entity Type:Individual
Prefix:
First Name:SHALVI
Middle Name:RUTUL
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHALVI
Other - Middle Name:SHRENIKBHAI
Other - Last Name:SHETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:233 E WACKER DR
Mailing Address - Street 2:APT 2806
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-5104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2930 N. MANHEIM ROAD
Practice Address - Street 2:SUIT 3A
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131
Practice Address - Country:US
Practice Address - Phone:847-451-9244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017848225100000X
NY032690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist