Provider Demographics
NPI:1942697602
Name:SHAH, KIRAT (PT,MPT,CWS,CLT-LANA)
Entity Type:Individual
Prefix:MR
First Name:KIRAT
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:PT,MPT,CWS,CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 RIDGEGATE PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-4682
Mailing Address - Country:US
Mailing Address - Phone:517-918-4849
Mailing Address - Fax:
Practice Address - Street 1:2916 RIDGEGATE PL
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-4682
Practice Address - Country:US
Practice Address - Phone:517-918-4849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist