Provider Demographics
NPI:1891162350
Name:SHETH, BIJAL
Entity Type:Individual
Prefix:
First Name:BIJAL
Middle Name:
Last Name:SHETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BIJAL
Other - Middle Name:
Other - Last Name:SHETH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1000 BURR RIDGE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0849
Mailing Address - Country:US
Mailing Address - Phone:630-920-4670
Mailing Address - Fax:630-920-4687
Practice Address - Street 1:1850 W WINCHESTER RD
Practice Address - Street 2:#223
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5357
Practice Address - Country:US
Practice Address - Phone:630-920-4670
Practice Address - Fax:630-920-4687
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.021496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist