Provider Demographics
NPI:1174854228
Name:SHAH, NANDITA (PT)
Entity Type:Individual
Prefix:MS
First Name:NANDITA
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 1:9236 OLD VERANDA RD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7082
Mailing Address - Country:US
Mailing Address - Phone:312-799-9949
Mailing Address - Fax:
Practice Address - Street 1:5804 COIT RD STE 108
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5957
Practice Address - Country:US
Practice Address - Phone:972-767-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017411225100000X
TX1246537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1246537OtherTEXAS BOARD OF PHYSICAL THERAPY EXAMINERS
IL070017411OtherDEPARTMENT OF PROFESSIONAL REGULATION