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General NPI Number Information
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NPI Number | 1417114281
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Entity Type | Individual
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Provider Name | NIRAV ANILKUMAR SHAH PT
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Gender | Male
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 6001 OAKBEND ST APT 8104
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City | ORLANDO
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State | FL
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Zip | 32835-2808
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Country | US
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Telephone | 248-982-8088
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Fax | 407-362-1940
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Provider Business Mailing Address
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Address Line | 6001 OAKBEND ST APT 8104
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City | ORLANDO
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State | FL
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Zip | 32835-2808
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Country | US
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Telephone | 248-982-8088
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Fax | 407-362-1940
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501012206
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT 29973
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License Number State | FL
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