Provider Demographics
NPI:1689990293
Name:SHAH, MEGHNA PRAMOD (PT)
Entity Type:Individual
Prefix:
First Name:MEGHNA
Middle Name:PRAMOD
Last Name:SHAH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 N ELM ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3635
Mailing Address - Country:US
Mailing Address - Phone:630-321-0055
Mailing Address - Fax:630-321-0088
Practice Address - Street 1:908 N ELM ST
Practice Address - Street 2:SUITE 109
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3635
Practice Address - Country:US
Practice Address - Phone:630-321-0055
Practice Address - Fax:630-321-0088
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist