Provider Demographics
NPI:1134378920
Name:SHAH, NEHA (MPT)
Entity type:Individual
Prefix:MRS
First Name:NEHA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 LINCOLN BLVD # 136
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-4619
Mailing Address - Country:US
Mailing Address - Phone:323-655-8528
Mailing Address - Fax:323-951-0068
Practice Address - Street 1:544 S SAN VICENTE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4622
Practice Address - Country:US
Practice Address - Phone:323-655-8525
Practice Address - Fax:323-951-0068
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289742251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic