Provider Demographics
NPI:1962644617
Name:SHAH, CHINTAN (RPT)
Entity Type:Individual
Prefix:MR
First Name:CHINTAN
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-7206
Mailing Address - Country:US
Mailing Address - Phone:248-608-1386
Mailing Address - Fax:248-608-1399
Practice Address - Street 1:500 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-7206
Practice Address - Country:US
Practice Address - Phone:248-608-1386
Practice Address - Fax:248-608-1399
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist