Provider Demographics
NPI:1568957256
Name:AMIN, SHRUTI J (DPT)
Entity Type:Individual
Prefix:
First Name:SHRUTI
Middle Name:J
Last Name:AMIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SHRUTI
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:24630 WASHINGTON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6177
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:1695 S SAN JACINTO AVE STE C
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5103
Practice Address - Country:US
Practice Address - Phone:951-696-9353
Practice Address - Fax:951-973-7216
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CA294979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist