Provider Demographics
NPI:1215278130
Name:SHAH, POOJA S (BPT)
Entity type:Individual
Prefix:MRS
First Name:POOJA
Middle Name:S
Last Name:SHAH
Suffix:
Gender:F
Credentials:BPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18822 BENT WILLOW CIR APT 311
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-5340
Mailing Address - Country:US
Mailing Address - Phone:607-727-2603
Mailing Address - Fax:
Practice Address - Street 1:19785 CRYSTAL ROCK DR STE 309
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-4732
Practice Address - Country:US
Practice Address - Phone:240-724-6781
Practice Address - Fax:888-607-7117
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist