Provider Demographics
NPI:1477042174
Name:SHAH, MANSI DILIPKUMAR (DPT)
Entity type:Individual
Prefix:
First Name:MANSI
Middle Name:DILIPKUMAR
Last Name:SHAH
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 1:2103 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1727
Mailing Address - Country:US
Mailing Address - Phone:909-576-6714
Mailing Address - Fax:
Practice Address - Street 1:2103 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-1727
Practice Address - Country:US
Practice Address - Phone:909-576-6714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT019995225100000X
TX1298189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist