Provider Demographics
NPI:1891162350
Name:SHETH, BIJAL
Entity type:Individual
Prefix:
First Name:BIJAL
Middle Name:
Last Name:SHETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BIJAL
Other - Middle Name:
Other - Last Name:SHETH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1084 AVERY RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:555 AMERICA CT
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2677
Practice Address - Country:US
Practice Address - Phone:847-307-6990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.021496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist