Provider Demographics
NPI:1013159185
Name:SHAH, PURVI D (PT)
Entity Type:Individual
Prefix:
First Name:PURVI
Middle Name:D
Last Name:SHAH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PURVI
Other - Middle Name:ASHOKKUMAR
Other - Last Name:GAIWALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1663 STEPHENSON HWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2169
Mailing Address - Country:US
Mailing Address - Phone:248-327-6619
Mailing Address - Fax:248-327-6628
Practice Address - Street 1:1663 STEPHENSON HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2169
Practice Address - Country:US
Practice Address - Phone:248-327-6619
Practice Address - Fax:248-327-6628
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013122225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501013122OtherPHYSICAL THERAPY LICENSE