MEDICARE: MRS. RUCHI R SHAH PT

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	032501-1	NY

General Provider Information

NPI Number	:	1619294717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RUCHI R SHAH PT

Provider Business Mailing Address
First Line	:	710 PARKSIDE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-1508
Country	:	US
Telephone Number	:	718-282-7800
Fax Number	:	718-282-7838

Provider Business Practice Location Address
First Line	:	710 PARKSIDE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-1508
Country	:	US
Telephone Number	:	718-282-7800
Fax Number	:	718-282-7838

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

Provider Enumeration Date	:	04/28/2010
Last Update Date	:	07/26/2012

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