Provider Demographics
NPI:1588470314
Name:DEDHIA, SHAILEY (PT)
Entity type:Individual
Prefix:
First Name:SHAILEY
Middle Name:
Last Name:DEDHIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SHAILEY
Other - Middle Name:
Other - Last Name:DEDHIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9201 TERREL ST
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:TX
Mailing Address - Zip Code:76226-1946
Mailing Address - Country:US
Mailing Address - Phone:469-515-3844
Mailing Address - Fax:
Practice Address - Street 1:9201 TERREL ST
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:TX
Practice Address - Zip Code:76226-1946
Practice Address - Country:US
Practice Address - Phone:469-515-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1254476225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist