Provider Demographics
NPI:1528595212
Name:SHAH, PALAK DWEEPKUMAR
Entity Type:Individual
Prefix:
First Name:PALAK
Middle Name:DWEEPKUMAR
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 116TH STREET CT SW
Mailing Address - Street 2:APT K
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-1362
Mailing Address - Country:US
Mailing Address - Phone:862-686-9125
Mailing Address - Fax:
Practice Address - Street 1:10401 116TH ST CT SW
Practice Address - Street 2:APT K
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498
Practice Address - Country:US
Practice Address - Phone:862-686-9125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 32422225100000X
DEJ1-0003464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist