Provider Demographics
NPI:1265892491
Name:MALKANI, RESHMA
Entity type:Individual
Prefix:
First Name:RESHMA
Middle Name:
Last Name:MALKANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RESHMA
Other - Middle Name:
Other - Last Name:MALKANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:911 W LOIRE CT
Mailing Address - Street 2:APT 303
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1856
Mailing Address - Country:US
Mailing Address - Phone:507-210-8870
Mailing Address - Fax:
Practice Address - Street 1:911 W LOIRE CT
Practice Address - Street 2:APT 303
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1856
Practice Address - Country:US
Practice Address - Phone:507-210-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.2733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist