Provider Demographics
NPI:1184063836
Name:THADANI, SIMRAN PRAVEEN (PT)
Entity type:Individual
Prefix:MRS
First Name:SIMRAN
Middle Name:PRAVEEN
Last Name:THADANI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:RESHMA
Other - Middle Name:HIRALAL
Other - Last Name:AHUJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3015 BELLA CT
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1696
Mailing Address - Country:US
Mailing Address - Phone:630-857-9507
Mailing Address - Fax:
Practice Address - Street 1:3015 BELLA CT
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1696
Practice Address - Country:US
Practice Address - Phone:630-857-9507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.009691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist