Provider Demographics
NPI:1376096578
Name:SHAH, DIPALI MISHAL (PT)
Entity Type:Individual
Prefix:
First Name:DIPALI
Middle Name:MISHAL
Last Name:SHAH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DIPALI
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:20823 STEVENS CREEK BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2112
Mailing Address - Country:US
Mailing Address - Phone:510-790-3213
Mailing Address - Fax:510-790-3337
Practice Address - Street 1:1895 MOWRY AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1737
Practice Address - Country:US
Practice Address - Phone:510-790-3213
Practice Address - Fax:510-790-3337
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT291593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist