Provider Demographics
NPI:1619294717
Name:SHAH, RUCHI R (PT)
Entity Type:Individual
Prefix:MRS
First Name:RUCHI
Middle Name:R
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 1:710 PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-1508
Mailing Address - Country:US
Mailing Address - Phone:718-282-7800
Mailing Address - Fax:718-282-7838
Practice Address - Street 1:710 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-1508
Practice Address - Country:US
Practice Address - Phone:718-282-7800
Practice Address - Fax:718-282-7838
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032501-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist