Provider Demographics
NPI:1790341337
Name:SHAHIWALA, JALDHIBEN
Entity Type:Individual
Prefix:
First Name:JALDHIBEN
Middle Name:
Last Name:SHAHIWALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JALDHIBEN
Other - Middle Name:
Other - Last Name:SHAHIWALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:928 GLEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1526
Mailing Address - Country:US
Mailing Address - Phone:909-728-3670
Mailing Address - Fax:
Practice Address - Street 1:6225 N STATE HIGHWAY 161 STE 350
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2256
Practice Address - Country:US
Practice Address - Phone:817-916-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-18
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1305790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist