Provider Demographics
NPI:1922419563
Name:NEHA SHAH PT INC
Entity Type:Organization
Organization Name:NEHA SHAH PT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:818-634-0376
Mailing Address - Street 1:2633 LINCOLN BLVD
Mailing Address - Street 2:136
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-4619
Mailing Address - Country:US
Mailing Address - Phone:818-634-0376
Mailing Address - Fax:323-677-2123
Practice Address - Street 1:544 S SAN VICENTE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4622
Practice Address - Country:US
Practice Address - Phone:323-655-8528
Practice Address - Fax:323-677-2123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty