Provider Demographics
NPI:1750488482
Name:SHAH, CHETNA H (PT)
Entity Type:Individual
Prefix:
First Name:CHETNA
Middle Name:H
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 1:13640 N PLAZA DEL RIO BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:623-876-3800
Mailing Address - Fax:623-876-3975
Practice Address - Street 1:13760 N 93RD AVE
Practice Address - Street 2:STE 107
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4201
Practice Address - Country:US
Practice Address - Phone:623-876-3952
Practice Address - Fax:623-876-3975
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4039225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ111289Medicare PIN
AZZ111290Medicare PIN
AZP00340391Medicare PIN