Provider Demographics
NPI:1952605768
Name:SHAH, NIMISHA DARSHAN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:NIMISHA
Middle Name:DARSHAN
Last Name:SHAH
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9007 MAGNA LN
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-5216
Mailing Address - Country:US
Mailing Address - Phone:704-698-2104
Mailing Address - Fax:
Practice Address - Street 1:9007 MAGNA LN
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5216
Practice Address - Country:US
Practice Address - Phone:704-698-2104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-08
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist