Provider Demographics
NPI:1760228357
Name:SHAH, NANDAN ASHOKBHAI (PT)
Entity type:Individual
Prefix:
First Name:NANDAN
Middle Name:ASHOKBHAI
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 1:6415 MOONSTONE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7811
Mailing Address - Country:US
Mailing Address - Phone:810-275-8982
Mailing Address - Fax:
Practice Address - Street 1:8338 ALLEN RD STE 102B
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1399
Practice Address - Country:US
Practice Address - Phone:313-438-0963
Practice Address - Fax:313-438-0974
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist