Provider Demographics
NPI:1255728929
Name:SHAH, JUEE (PT,MPT,DPT,CLT,WCC)
Entity type:Individual
Prefix:DR
First Name:JUEE
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:PT,MPT,DPT,CLT,WCC
Other - Prefix:
Other - First Name:JUEE
Other - Middle Name:M
Other - Last Name:BHAVSAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,MPT,DPT,CLT,WCC
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:517-505-5879
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:517-505-5879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206246225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist