Provider Demographics
NPI:1750376711
Name:SHAH, KETKI P (PT)
Entity type:Individual
Prefix:MRS
First Name:KETKI
Middle Name:P
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 1:101 FORBES DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-7200
Mailing Address - Country:US
Mailing Address - Phone:270-889-9996
Mailing Address - Fax:270-889-9993
Practice Address - Street 1:101 FORBES DRIVE
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1914
Practice Address - Country:US
Practice Address - Phone:270-889-9996
Practice Address - Fax:270-889-9993
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT-002593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist