| Doctor Name: | SIDDHI VIRENDRA BAVISHI |
| NPI Number: | 1063769487 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | 070.019638 |
| Business Practice Address: | 1095 Pingree Rd Suite 119 Crystal Lake, IL - 600141725 |
| Business Phone Number: | 8474588890 |
| Business Fax Number: | 8474588889 |
| Mailing Address: | 1095 Pingree Rd, Suite 119 CRYSTAL LAKE |
| State: | IL |
| Postal Code: | 600141725 |
| Phone Number: | 8474588890 |
| Fax Number: | 8474588889 |
| NPI Enumeration Date: | 08/06/2012 |
| NPI Last Update Date: | 12/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251P0200X |
| License Number: | 070.019638 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |