MEDICARE: POOJA SHAH P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070021152	IL
2	225100000X	Physical Therapist	05011595A	IN
3	225100000X	Physical Therapist	037684	NY

General Provider Information

NPI Number	:	1003205493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POOJA SHAH P.T.

Provider Business Mailing Address
First Line	:	1514 KINGSTON CT
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-1478
Country	:	US
Telephone Number	:	317-900-6794
Fax Number	:

Provider Business Practice Location Address
First Line	:	1514 KINGSTON CT
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-1478
Country	:	US
Telephone Number	:	317-900-6794
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2015
Last Update Date	:	01/22/2015

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Directions to “ POOJA SHAH P.T.” Practice Location

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