Provider Demographics
NPI:1497031082
Name:PASULA, SHALINI
Entity Type:Individual
Prefix:MRS
First Name:SHALINI
Middle Name:
Last Name:PASULA
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 1:406 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2014
Mailing Address - Country:US
Mailing Address - Phone:773-701-3296
Mailing Address - Fax:
Practice Address - Street 1:406 W 5TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2014
Practice Address - Country:US
Practice Address - Phone:773-701-3296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019470225100000X
MI5501015084225100000X
IN05010273A225100000X
CA292693225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist