Provider Demographics
NPI:1780973818
Name:DOMENIGHETTI, SHIORI
Entity type:Individual
Prefix:
First Name:SHIORI
Middle Name:
Last Name:DOMENIGHETTI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SHIORI
Other - Middle Name:
Other - Last Name:MURAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 RAND RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2359
Mailing Address - Country:US
Mailing Address - Phone:847-324-3976
Mailing Address - Fax:847-929-1154
Practice Address - Street 1:3000 N HALSTED ST STE 527
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-9269
Practice Address - Country:US
Practice Address - Phone:773-328-5930
Practice Address - Fax:773-433-3125
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-015610225X00000X
IL160.007275225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist