Provider Demographics
NPI:1568782886
Name:SHAH, PALAK DALVAK (PT)
Entity Type:Individual
Prefix:
First Name:PALAK
Middle Name:DALVAK
Last Name:SHAH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44190 BOITANO DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-6332
Mailing Address - Country:US
Mailing Address - Phone:408-823-1214
Mailing Address - Fax:
Practice Address - Street 1:16185 LOS GATOS BLVD STE 205
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-4569
Practice Address - Country:US
Practice Address - Phone:408-823-1214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 36736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEB660ZMedicare PIN