Provider Demographics
NPI:1346730652
Name:SHUKLA, RUCHITA SHAH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:RUCHITA
Middle Name:SHAH
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6065 MERIDIAN AVE STE 70
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-2772
Mailing Address - Country:US
Mailing Address - Phone:408-927-0871
Mailing Address - Fax:408-927-0891
Practice Address - Street 1:6065 MERIDIAN AVE STE 70
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2772
Practice Address - Country:US
Practice Address - Phone:408-927-0871
Practice Address - Fax:408-927-0891
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49324225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant