Provider Demographics
NPI:1053400903
Name:VENKAT, SHANTHI V
Entity type:Individual
Prefix:MRS
First Name:SHANTHI
Middle Name:V
Last Name:VENKAT
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 1:13984 ECKEL JUNCTION RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5711
Mailing Address - Country:US
Mailing Address - Phone:418-872-1644
Mailing Address - Fax:
Practice Address - Street 1:3333 GLENDALE AVE
Practice Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:41614
Practice Address - Country:US
Practice Address - Phone:419-259-2037
Practice Address - Fax:419-259-2008
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010058862251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary