Basic Information
Provider Information | |||||||||
NPI: | 1508096751 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SHAH | ||||||||
FirstName: | SHWETA | ||||||||
MiddleName: | GADA | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.P.T. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 224 N FAIR OAKS AVE | ||||||||
Address2: | 3RD FLOOR | ||||||||
City: | PASADENA | ||||||||
State: | CA | ||||||||
PostalCode: | 911033618 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6266961400 | ||||||||
FaxNumber: | 6266961450 | ||||||||
Practice Location | |||||||||
Address1: | 440 E HUNTINGTON DR | ||||||||
Address2: |   | ||||||||
City: | ARCADIA | ||||||||
State: | CA | ||||||||
PostalCode: | 910063776 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6266231123 | ||||||||
FaxNumber: | 6266231130 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/22/2009 | ||||||||
LastUpdateDate: | 12/21/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 22930 | MD | N |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   | 225100000X | PT37367 | CA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.