Provider Demographics
NPI:1699078451
Name:SHAH, KAVITA M (RPT)
Entity type:Individual
Prefix:
First Name:KAVITA
Middle Name:M
Last Name:SHAH
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6620 HIGHLAND RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1682
Mailing Address - Country:US
Mailing Address - Phone:248-666-6001
Mailing Address - Fax:248-666-6009
Practice Address - Street 1:6620 HIGHLAND RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1682
Practice Address - Country:US
Practice Address - Phone:248-666-6001
Practice Address - Fax:248-666-6009
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501014699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist