Provider Demographics
NPI:1760044911
Name:SHAH, SIDDHI (PT)
Entity Type:Individual
Prefix:
First Name:SIDDHI
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 1:6489 CAMDEN AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-2850
Mailing Address - Country:US
Mailing Address - Phone:408-268-0600
Mailing Address - Fax:415-570-2236
Practice Address - Street 1:6489 CAMDEN AVE STE 109
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2850
Practice Address - Country:US
Practice Address - Phone:408-268-0600
Practice Address - Fax:415-570-2236
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019131225100000X
NCP20527225100000X
CA302001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist