Provider Demographics
NPI:1760841803
Name:SHAH, DHWANI
Entity Type:Individual
Prefix:
First Name:DHWANI
Middle Name:
Last Name:SHAH
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 1:6542 N ASHLAND AVE
Mailing Address - Street 2:APT 1E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4934
Mailing Address - Country:US
Mailing Address - Phone:412-961-4500
Mailing Address - Fax:
Practice Address - Street 1:2043 TOWER DR
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-7803
Practice Address - Country:US
Practice Address - Phone:866-459-0059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.021969225100000X
MD25784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist