Provider Demographics
NPI:1427482769
Name:SHAH, RICHA (DPT)
Entity type:Individual
Prefix:
First Name:RICHA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 132ND ST SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8999
Mailing Address - Country:US
Mailing Address - Phone:425-316-8046
Mailing Address - Fax:425-338-9637
Practice Address - Street 1:10207 19TH AVE SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4257
Practice Address - Country:US
Practice Address - Phone:425-337-3166
Practice Address - Fax:425-338-4596
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60405125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0314406OtherL & I
WA0314698OtherL & I
WA0314697OtherL & I
WA0314692OtherL & I
WA0314406OtherL & I
WA0314697OtherL & I
WA0314692OtherL & I
WAG8923016Medicare PIN