Provider Demographics
NPI:1700559853
Name:SHAH, ADITI DHAVAL (PT)
Entity Type:Individual
Prefix:
First Name:ADITI
Middle Name:DHAVAL
Last Name:SHAH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 BEAR LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75036-1086
Mailing Address - Country:US
Mailing Address - Phone:425-362-8685
Mailing Address - Fax:
Practice Address - Street 1:7548 PRESTON RD STE 145
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5684
Practice Address - Country:US
Practice Address - Phone:972-712-9693
Practice Address - Fax:972-712-9625
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1345660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist