Provider Demographics
NPI:1881062933
Name:TUMMINELLO, RADHIKA SHAH (DPT)
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:SHAH
Last Name:TUMMINELLO
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:RADHIKA
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:213 GREENHILL AVE STE C
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-1800
Practice Address - Country:US
Practice Address - Phone:302-658-7800
Practice Address - Fax:302-658-1550
Is Sole Proprietor?:No
Enumeration Date:2015-09-07
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE225100000X
2255A2300X
DEJ1-0004109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer