Provider Demographics
NPI:1417114281
Name:SHAH, NIRAV ANILKUMAR (PT)
Entity Type:Individual
Prefix:MR
First Name:NIRAV
Middle Name:ANILKUMAR
Last Name:SHAH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 OAKBEND ST APT 8104
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2808
Mailing Address - Country:US
Mailing Address - Phone:248-982-8088
Mailing Address - Fax:407-362-1940
Practice Address - Street 1:6001 OAKBEND ST APT 8104
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-2808
Practice Address - Country:US
Practice Address - Phone:248-982-8088
Practice Address - Fax:407-362-1940
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012206225100000X
FLPT 29973261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy