Provider Demographics
NPI:1639378003
Name:SHAH, PURVI KIRIT
Entity Type:Individual
Prefix:
First Name:PURVI
Middle Name:KIRIT
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31102 MORLOCK ST
Mailing Address - Street 2:601
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1651
Mailing Address - Country:US
Mailing Address - Phone:248-982-3657
Mailing Address - Fax:248-888-1325
Practice Address - Street 1:31102 MORLOCK ST
Practice Address - Street 2:601
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1651
Practice Address - Country:US
Practice Address - Phone:248-982-3657
Practice Address - Fax:248-888-1325
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist