=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770583965
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAYAL BHARAT SHAH MPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2005
-----------------------------------------------------
Last Update Date | 04/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 466 GERMANTOWN PIKE STE 200
-----------------------------------------------------
City | LAFAYETTE HILL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19444-1805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-832-7510
-----------------------------------------------------
Fax | 610-832-5964
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 466 GERMANTOWN PIKE STE 200
-----------------------------------------------------
City | LAFAYETTE HILL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19444-1805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-832-7510
-----------------------------------------------------
Fax | 610-832-5964
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT016190
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------