Provider Demographics
NPI:1407001530
Name:SHAH, PAVANIBEN N (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:PAVANIBEN
Middle Name:N
Last Name:SHAH
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GARDEN TER
Mailing Address - Street 2:APT 21F
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-6200
Mailing Address - Country:US
Mailing Address - Phone:551-998-3238
Mailing Address - Fax:
Practice Address - Street 1:41 W 96TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6519
Practice Address - Country:US
Practice Address - Phone:551-998-3238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029933174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist