Provider Demographics
NPI:1508887340
Name:SHAH, PALLAVI (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:PALLAVI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:PALLAVI
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:359 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-6708
Mailing Address - Country:US
Mailing Address - Phone:703-944-4257
Mailing Address - Fax:
Practice Address - Street 1:359 PARK AVE
Practice Address - Street 2:
Practice Address - City:WEEHAWKEN
Practice Address - State:NJ
Practice Address - Zip Code:07086-6708
Practice Address - Country:US
Practice Address - Phone:703-944-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870681225100000X
VA2305205246225100000X
MI5501012816225100000X
NJ40QA018385002251X0800X
MD22183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic