Provider Demographics
NPI:1558602524
Name:MUGVE, SHAINA D (PT)
Entity Type:Individual
Prefix:
First Name:SHAINA
Middle Name:D
Last Name:MUGVE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHAINA
Other - Middle Name:D
Other - Last Name:YORKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-3251
Practice Address - Street 1:16651 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2895
Practice Address - Country:US
Practice Address - Phone:708-444-2467
Practice Address - Fax:708-444-2758
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist