Provider Demographics
NPI:1548737067
Name:SHAH, MANSI GAURAV
Entity Type:Individual
Prefix:
First Name:MANSI
Middle Name:GAURAV
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MANSIBEN
Other - Middle Name:DEVANGKUMAR
Other - Last Name:CHOKSHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9211 CALABRIAN PINE CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1794
Mailing Address - Country:US
Mailing Address - Phone:832-420-2327
Mailing Address - Fax:
Practice Address - Street 1:9211 CALABRIAN PINE CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-1794
Practice Address - Country:US
Practice Address - Phone:832-420-2327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1306762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty