Provider Demographics
NPI:1124380787
Name:SHAH, PRACHI (PT)
Entity Type:Individual
Prefix:
First Name:PRACHI
Middle Name:
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 1:364B FM 1959 RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-5414
Mailing Address - Country:US
Mailing Address - Phone:281-974-5095
Mailing Address - Fax:281-974-5109
Practice Address - Street 1:364B FM 1959 ROAD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-1110
Practice Address - Country:US
Practice Address - Phone:281-974-5095
Practice Address - Fax:281-974-5109
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12059092251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary