Provider Demographics
NPI:1538598222
Name:SHENOY, SAMRUDDHA (PT, MPT)
Entity type:Individual
Prefix:
First Name:SAMRUDDHA
Middle Name:
Last Name:SHENOY
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9. RUBY MANSION, 1ST FLOOR,
Mailing Address - Street 2:GOWALIA TANK RD
Mailing Address - City:MUMBAI
Mailing Address - State:FOREIGN PROVINCE
Mailing Address - Zip Code:400036
Mailing Address - Country:IN
Mailing Address - Phone:9122-385-9788
Mailing Address - Fax:
Practice Address - Street 1:15229 CATALINA DR
Practice Address - Street 2:UNIT 3A
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4390
Practice Address - Country:US
Practice Address - Phone:818-426-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL07009054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist