Individual
SHAKTI BANWAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1534 119TH ST, WHITING, IN 46394-1733
(219) 655-5285
Mailing address
1534 119TH ST, WHITING, IN 46394-1733
(219) 655-5285
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06005015A
IN
225200000X
Physical Therapy Assistant
160006962
IL
Other
Enumeration date
03/22/2019
Last updated
03/22/2019
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