Provider Demographics
NPI:1134454309
Name:SHAHIDI, BAHAR (DPT)
Entity type:Individual
Prefix:DR
First Name:BAHAR
Middle Name:
Last Name:SHAHIDI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-4835
Mailing Address - Country:US
Mailing Address - Phone:510-847-7769
Mailing Address - Fax:
Practice Address - Street 1:320 E 1ST AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-3786
Practice Address - Country:US
Practice Address - Phone:303-460-0329
Practice Address - Fax:303-460-0387
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105172251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic