Provider Demographics
NPI:1821385105
Name:SHAH, PALAK (PT)
Entity Type:Individual
Prefix:MISS
First Name:PALAK
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 1:333 WILLOW ST APT 407
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4068
Mailing Address - Country:US
Mailing Address - Phone:248-636-3279
Mailing Address - Fax:
Practice Address - Street 1:333 WILLOW ST APT 407
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4068
Practice Address - Country:US
Practice Address - Phone:248-636-3279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033485225100000X
MI5501014735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist