Basic Information
| Provider Information | |||||||||
| NPI: | 1801121280 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAXENA | ||||||||
| FirstName: | SHUBHANSHU | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 N WABASH RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MARION | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469521300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656513229 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465285010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5745330351 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2009 | ||||||||
| LastUpdateDate: | 10/02/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 05009793A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.