Provider Demographics
NPI:1962644617
Name:SHAH, CHINTAN (RPT)
Entity type:Individual
Prefix:MR
First Name:CHINTAN
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11363 SAN ELIA DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-1276
Mailing Address - Country:US
Mailing Address - Phone:248-312-9052
Mailing Address - Fax:
Practice Address - Street 1:11363 SAN ELIA DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-1276
Practice Address - Country:US
Practice Address - Phone:248-312-9052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist