Provider Demographics
NPI:1265610018
Name:SHAH, NIMESH (RPT)
Entity type:Individual
Prefix:MR
First Name:NIMESH
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 1:1380 COOLIDGE HWY STE 180
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-7067
Mailing Address - Country:US
Mailing Address - Phone:248-435-8420
Mailing Address - Fax:248-435-8491
Practice Address - Street 1:1380 COOLIDGE HWY STE 180
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7067
Practice Address - Country:US
Practice Address - Phone:248-435-8420
Practice Address - Fax:248-435-8491
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist