Provider Demographics
NPI:1619986072
Name:SHAH, PETER ALEXANDER (PT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:ALEXANDER
Last Name:SHAH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HARRISON ST
Mailing Address - Street 2:#819
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-2000
Mailing Address - Country:US
Mailing Address - Phone:415-297-5465
Mailing Address - Fax:
Practice Address - Street 1:201 HARRISON ST
Practice Address - Street 2:#819
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-2000
Practice Address - Country:US
Practice Address - Phone:415-297-5465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT261890Medicare PIN