Provider Demographics
NPI:1194963322
Name:SHETH, PRIYAL A (MPT)
Entity type:Individual
Prefix:MR
First Name:PRIYAL
Middle Name:A
Last Name:SHETH
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 CHELSEA CT
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:OH
Mailing Address - Zip Code:45152-8469
Mailing Address - Country:US
Mailing Address - Phone:513-290-1879
Mailing Address - Fax:513-899-9219
Practice Address - Street 1:1357 CHELSEA CT
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:OH
Practice Address - Zip Code:45152-8469
Practice Address - Country:US
Practice Address - Phone:513-290-1879
Practice Address - Fax:513-899-9219
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-10719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100091910Medicaid
KY0389238Medicare PIN