MEDICARE: MRS. RUCHITA SHAH SHUKLA PTA

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	225200000X	Physical Therapy Assistant	49324	CA

General Provider Information

NPI Number	:	1346730652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RUCHITA SHAH SHUKLA PTA

Provider Business Mailing Address
First Line	:	6065 MERIDIAN AVE STE 70
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-2772
Country	:	US
Telephone Number	:	408-927-0871
Fax Number	:	408-927-0891

Provider Business Practice Location Address
First Line	:	6065 MERIDIAN AVE STE 70
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-2772
Country	:	US
Telephone Number	:	408-927-0871
Fax Number	:	408-927-0891

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

Provider Enumeration Date	:	05/11/2018
Last Update Date	:	05/11/2018

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