Provider Demographics
NPI:1235735119
Name:SHAH, KARAN SANDIP (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KARAN
Middle Name:SANDIP
Last Name:SHAH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7077 W 130TH ST APT 142K
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7867
Mailing Address - Country:US
Mailing Address - Phone:412-608-9516
Mailing Address - Fax:
Practice Address - Street 1:684 AVON BELDEN RD STE B
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-4111
Practice Address - Country:US
Practice Address - Phone:440-930-5537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty