Provider Demographics
NPI:1518394808
Name:SHAH, ANKUR (PT)
Entity Type:Individual
Prefix:
First Name:ANKUR
Middle Name:
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 1:6519 WOODLAKE VILLAGE CT
Mailing Address - Street 2:APT D
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2226
Mailing Address - Country:US
Mailing Address - Phone:951-790-9623
Mailing Address - Fax:
Practice Address - Street 1:6519 WOODLAKE VILLAGE CT
Practice Address - Street 2:APT D
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2226
Practice Address - Country:US
Practice Address - Phone:951-790-9623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist