Provider Demographics
NPI:1891096509
Name:SHAHANI, MANISHA KIRAN (PT)
Entity Type:Individual
Prefix:
First Name:MANISHA
Middle Name:KIRAN
Last Name:SHAHANI
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 1:2145 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1141
Mailing Address - Country:US
Mailing Address - Phone:408-248-6886
Mailing Address - Fax:408-248-4923
Practice Address - Street 1:800 FOSTER CITY BLVD
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-2228
Practice Address - Country:US
Practice Address - Phone:650-571-5185
Practice Address - Fax:650-571-5183
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 37302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEW703YMedicare PIN
CAZZZ06873ZMedicare PIN
CAEW703ZMedicare PIN