Provider Demographics
NPI:1396821088
Name:SHAH, DIPTI V (RPT)
Entity Type:Individual
Prefix:MRS
First Name:DIPTI
Middle Name:V
Last Name:SHAH
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1637
Mailing Address - Country:US
Mailing Address - Phone:617-846-5352
Mailing Address - Fax:
Practice Address - Street 1:871 TURNPIKE ST
Practice Address - Street 2:STE 108
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-6127
Practice Address - Country:US
Practice Address - Phone:617-846-5352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA8213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0365041Medicaid
MA0365041Medicaid