Provider Demographics
NPI:1902334071
Name:SHAH, ANKIT MINESH (PT)
Entity type:Individual
Prefix:
First Name:ANKIT
Middle Name:MINESH
Last Name:SHAH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 E WHITMORE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-2800
Mailing Address - Country:US
Mailing Address - Phone:209-622-4149
Mailing Address - Fax:209-622-4159
Practice Address - Street 1:2908 E WHITMORE AVE STE E
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-2800
Practice Address - Country:US
Practice Address - Phone:209-622-4149
Practice Address - Fax:209-622-4159
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26429225100000X
CA297491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist