Provider Demographics
NPI:1215450754
Name:SHAH, DHARTI V
Entity type:Individual
Prefix:
First Name:DHARTI
Middle Name:V
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-5699 KOPIKO ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-3651
Mailing Address - Country:US
Mailing Address - Phone:808-322-8400
Mailing Address - Fax:808-334-1608
Practice Address - Street 1:75-5699 KOPIKO ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3651
Practice Address - Country:US
Practice Address - Phone:808-322-8400
Practice Address - Fax:808-334-1608
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT872092225100000X
HIPT-5127225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist