Provider Demographics
NPI:1487536421
Name:KANADIYA, SHITAL RAMESH
Entity type:Individual
Prefix:
First Name:SHITAL
Middle Name:RAMESH
Last Name:KANADIYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 CANYONCREST WAY
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-2618
Mailing Address - Country:US
Mailing Address - Phone:510-941-8340
Mailing Address - Fax:
Practice Address - Street 1:6301 W PARMER LN STE 102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-6802
Practice Address - Country:US
Practice Address - Phone:512-527-6479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1399694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist