Provider Demographics
NPI:1447597323
Name:SHAFI, SHABEEBA PALLICKAL (PT)
Entity Type:Individual
Prefix:
First Name:SHABEEBA
Middle Name:PALLICKAL
Last Name:SHAFI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1952 E FORT UNION BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6877
Mailing Address - Country:US
Mailing Address - Phone:801-456-8409
Mailing Address - Fax:801-456-8413
Practice Address - Street 1:815 SE KLEMGARD ST
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5430
Practice Address - Country:US
Practice Address - Phone:509-334-9488
Practice Address - Fax:509-334-6819
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60293643225100000X
NY031422225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist