Provider Demographics
NPI:1669773180
Name:PAWAR, SHALAKA (MPT)
Entity type:Individual
Prefix:MRS
First Name:SHALAKA
Middle Name:
Last Name:PAWAR
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:SHALAKA
Other - Middle Name:
Other - Last Name:KALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:21118 CHASE DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-4750
Mailing Address - Country:US
Mailing Address - Phone:734-239-1253
Mailing Address - Fax:
Practice Address - Street 1:21118 CHASE DR
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-4750
Practice Address - Country:US
Practice Address - Phone:734-239-1253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist