Provider Demographics
NPI:1588364129
Name:PATIL, SHRADDHA (DPT)
Entity type:Individual
Prefix:MS
First Name:SHRADDHA
Middle Name:
Last Name:PATIL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 N LAKE SHORE DR APT 2120
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4628
Mailing Address - Country:US
Mailing Address - Phone:773-829-6514
Mailing Address - Fax:
Practice Address - Street 1:8616 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5182
Practice Address - Country:US
Practice Address - Phone:718-833-4656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist