Provider Demographics
NPI:1558568014
Name:SHAHANI, RAM B (PT, OCS)
Entity Type:Individual
Prefix:MR
First Name:RAM
Middle Name:B
Last Name:SHAHANI
Suffix:
Gender:M
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2576 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024
Mailing Address - Country:US
Mailing Address - Phone:770-962-4043
Mailing Address - Fax:770-962-4045
Practice Address - Street 1:2576 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2537
Practice Address - Country:US
Practice Address - Phone:770-962-4043
Practice Address - Fax:770-962-4045
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBCBZMedicare PIN