Provider Demographics
NPI:1306443874
Name:SHAH, VASU T (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:VASU
Middle Name:T
Last Name:SHAH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-1535
Mailing Address - Country:US
Mailing Address - Phone:908-590-8052
Mailing Address - Fax:
Practice Address - Street 1:9 MOUNT BETHEL RD STE 203A
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5603
Practice Address - Country:US
Practice Address - Phone:908-350-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01941200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist