Provider Demographics
NPI:1083957096
Name:SHAH, KAVAN MUNESHBHAI (PT)
Entity Type:Individual
Prefix:
First Name:KAVAN
Middle Name:MUNESHBHAI
Last Name:SHAH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19015 TOWN CENTER DR STE 102
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-8995
Mailing Address - Country:US
Mailing Address - Phone:760-961-4240
Mailing Address - Fax:760-961-4705
Practice Address - Street 1:19015 TOWN CENTER DR STE 102
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-8995
Practice Address - Country:US
Practice Address - Phone:760-961-4240
Practice Address - Fax:760-961-4705
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 40049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA202371Medicare PIN
CACA202373Medicare PIN
CACB257432Medicare PIN
CACA202372Medicare PIN