1700215746 NPI number — NEEPA SHAH PT

Table of content: NEEPA SHAH PT (NPI 1700215746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700215746 NPI number — NEEPA SHAH PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
NEEPA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700215746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5211 MARSH ROAD
Provider Second Line Business Mailing Address:
OKEMOS HEALTH AND REHABILITATION CENTER,
Provider Business Mailing Address City Name:
OKEMOS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-319-1383
Provider Business Mailing Address Fax Number:
517-318-0258

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5211 MARSH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKEMOS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48864-1106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-319-1383
Provider Business Practice Location Address Fax Number:
517-318-0258
Provider Enumeration Date:
11/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 222Q00000X , with the licence number:  5501009943 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 5501009943 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251G0304X , with the licence number: 5501009943 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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