Provider Demographics
NPI:1194042762
Name:SHAH, PRATIK C (PT)
Entity Type:Individual
Prefix:
First Name:PRATIK
Middle Name:C
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 1:21 W 86TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3671
Mailing Address - Country:US
Mailing Address - Phone:212-580-0125
Mailing Address - Fax:212-580-0860
Practice Address - Street 1:21 W 86TH ST
Practice Address - Street 2:STE 101
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3671
Practice Address - Country:US
Practice Address - Phone:212-580-0125
Practice Address - Fax:212-580-0860
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist