Provider Demographics
NPI:1548500168
Name:KHAPARDE, SHUBHANGI TOMDEO
Entity type:Individual
Prefix:
First Name:SHUBHANGI
Middle Name:TOMDEO
Last Name:KHAPARDE
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 1:1316 TOWN CENTER DR APT 3132
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-7315
Mailing Address - Country:US
Mailing Address - Phone:269-216-1749
Mailing Address - Fax:
Practice Address - Street 1:1110 TOM ADAMS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753
Practice Address - Country:US
Practice Address - Phone:512-836-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24194225100000X
TX1299789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist