Provider Demographics
NPI:1043259583
Name:SHAH, JITEN KRISHNAKANT (LPT)
Entity Type:Individual
Prefix:MR
First Name:JITEN
Middle Name:KRISHNAKANT
Last Name:SHAH
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 W WHEATLAND RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4619
Mailing Address - Country:US
Mailing Address - Phone:972-296-1808
Mailing Address - Fax:972-296-3777
Practice Address - Street 1:419 W WHEATLAND RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4619
Practice Address - Country:US
Practice Address - Phone:972-296-1808
Practice Address - Fax:972-296-3777
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1015048208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1932229507OtherNPI
TX8F8673Medicare PIN