Provider Demographics
NPI:1508096751
Name:SHAH, SHWETA GADA (DPT)
Entity Type:Individual
Prefix:MS
First Name:SHWETA
Middle Name:GADA
Last Name:SHAH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:224 N FAIR OAKS AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3618
Mailing Address - Country:US
Mailing Address - Phone:626-696-1400
Mailing Address - Fax:626-696-1450
Practice Address - Street 1:440 E HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3776
Practice Address - Country:US
Practice Address - Phone:626-623-1123
Practice Address - Fax:626-623-1130
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22930225100000X
CAPT37367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFF851ZMedicare UPIN