Provider Demographics
NPI:1598038077
Name:SHAH, SHWETA (PT)
Entity Type:Individual
Prefix:
First Name:SHWETA
Middle Name:
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 1:11661 GRANADA ST
Mailing Address - Street 2:GENESIS REHAB SERVICES
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1473
Mailing Address - Country:US
Mailing Address - Phone:913-703-7641
Mailing Address - Fax:
Practice Address - Street 1:11661 GRANADA ST
Practice Address - Street 2:GENESIS REHAB SERVICES
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1473
Practice Address - Country:US
Practice Address - Phone:913-703-7641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015100225100000X
KS11-04994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist