Provider Demographics
NPI:1073176889
Name:SHAH, SHRITI S (PT)
Entity Type:Individual
Prefix:MISS
First Name:SHRITI
Middle Name:S
Last Name:SHAH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17754 PRESTON RD
Mailing Address - Street 2:ST 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5965
Mailing Address - Country:US
Mailing Address - Phone:469-343-4202
Mailing Address - Fax:
Practice Address - Street 1:17754 PRESTON RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5638
Practice Address - Country:US
Practice Address - Phone:469-343-4202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1329115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist