Provider Demographics
NPI:1215664321
Name:SHAH, DEVANSHI (PT, DPT, PCES)
Entity type:Individual
Prefix:
First Name:DEVANSHI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:PT, DPT, PCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4846 SIMCOE ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-6434
Mailing Address - Country:US
Mailing Address - Phone:904-510-8083
Mailing Address - Fax:
Practice Address - Street 1:12160 ABRAMS RD STE 506
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4650
Practice Address - Country:US
Practice Address - Phone:214-586-0254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT030691225100000X
TX1376928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist