Healthcare Provider Details

I. General information

NPI: 1669920203
Provider Name (Legal Business Name): ANAL A SHAH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CONCOURSE BLVD
SANTA ROSA CA
95403-8210
US

IV. Provider business mailing address

220 CONCOURSE BLVD
SANTA ROSA CA
95403-8210
US

V. Phone/Fax

Practice location:
  • Phone: 844-527-7369
  • Fax: 844-847-4943
Mailing address:
  • Phone: 844-527-7369
  • Fax: 844-847-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number296581
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number296581
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number296581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: