Provider Demographics
NPI:1205263167
Name:SHAH, NUTAN H (PT)
Entity type:Individual
Prefix:MRS
First Name:NUTAN
Middle Name:H
Last Name:SHAH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:NUTAN
Other - Middle Name:H
Other - Last Name:VORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:829 CARILLON DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-5300
Mailing Address - Country:US
Mailing Address - Phone:630-372-1983
Mailing Address - Fax:630-736-8442
Practice Address - Street 1:829 CARILLON DR
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-5300
Practice Address - Country:US
Practice Address - Phone:630-483-4735
Practice Address - Fax:630-736-8442
Is Sole Proprietor?:No
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070038792251G0304X
IL07038792251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146125Medicare PIN
IL2003382Medicare PIN