Provider Demographics
NPI:1578503744
Name:SHAH, SIMA K (DPT)
Entity Type:Individual
Prefix:
First Name:SIMA
Middle Name:K
Last Name:SHAH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 JOLIET ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1996
Mailing Address - Country:US
Mailing Address - Phone:219-864-3300
Mailing Address - Fax:219-864-2569
Practice Address - Street 1:1100 JOLIET ST
Practice Address - Street 2:SUITE 205
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1996
Practice Address - Country:US
Practice Address - Phone:219-864-3300
Practice Address - Fax:219-864-2569
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008167A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000306105OtherANTHEM - APT PLUS
IN000000320909OtherANTHEM - 1ST AID PLUS
IN000000324508OtherANTHEM - MBWOUDE
ILP00608812OtherRAILROAD GROUP MEMBER PTAN
IN000000306105OtherANTHEM - APT PLUS
IN214690EMedicare ID - Type UnspecifiedPART B GROUP MEMBER
IN000000320909OtherANTHEM - 1ST AID PLUS
IN214710AMedicare ID - Type UnspecifiedPART B GROUP MEMBER
INP00259766Medicare ID - Type UnspecifiedRR MEDICARE