Provider Demographics
NPI:1235737040
Name:SHASTRI, RUPA (MSPT,CLWT,CORE(CERT))
Entity Type:Individual
Prefix:MS
First Name:RUPA
Middle Name:
Last Name:SHASTRI
Suffix:
Gender:F
Credentials:MSPT,CLWT,CORE(CERT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 INDIAN ROCKS RD S
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-1026
Mailing Address - Country:US
Mailing Address - Phone:727-754-3477
Mailing Address - Fax:727-754-3473
Practice Address - Street 1:1603 INDIAN ROCKS RD S
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-1026
Practice Address - Country:US
Practice Address - Phone:727-754-3477
Practice Address - Fax:727-754-3473
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist