Healthcare Provider Details

I. General information

NPI: 1275850455
Provider Name (Legal Business Name): EKTA AMITKUMAR SHAH RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6182 CREEKSIDE CT
GRAND BLANC MI
48439-7445
US

IV. Provider business mailing address

6182 CREEKSIDE CT
GRAND BLANC MI
48439-7445
US

V. Phone/Fax

Practice location:
  • Phone: 810-394-1615
  • Fax:
Mailing address:
  • Phone: 810-394-1615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501014009
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: