MEDICARE: MR. KIRAT SHAH PT,MPT,CWS,CLT-LANA

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	2305206253	VA

General Provider Information

NPI Number	:	1942697602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KIRAT SHAH PT,MPT,CWS,CLT-LANA

Provider Business Mailing Address
First Line	:	2916 RIDGEGATE PL
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-4682
Country	:	US
Telephone Number	:	517-918-4849
Fax Number	:

Provider Business Practice Location Address
First Line	:	2916 RIDGEGATE PL
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-4682
Country	:	US
Telephone Number	:	517-918-4849
Fax Number	:

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

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	09/28/2016

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