MEDICARE: PREKSHA SHAH

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	078638	IA

General Provider Information

NPI Number	:	1255780896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PREKSHA SHAH

Provider Business Mailing Address
First Line	:	1641 PINEHURST DR NE
Second Line	:	APT 21C
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-5863
Country	:	US
Telephone Number	:	510-565-4693
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 5TH AVE SE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52403-4049
Country	:	US
Telephone Number	:	510-565-4693
Fax Number	:

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

Provider Enumeration Date	:	06/05/2016
Last Update Date	:	06/05/2016

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Directions to “ PREKSHA SHAH ” Practice Location

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