Provider Demographics
NPI:1942538830
Name:SHAH, RUCHI H (MPT)
Entity Type:Individual
Prefix:
First Name:RUCHI
Middle Name:H
Last Name:SHAH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2073 MUSTANG CHASE DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8182
Mailing Address - Country:US
Mailing Address - Phone:317-370-3373
Mailing Address - Fax:
Practice Address - Street 1:2073 MUSTANG CHASE DRIVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8182
Practice Address - Country:US
Practice Address - Phone:317-370-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist