Provider Demographics
NPI:1245809573
Name:SHAH, RUSHABH SANJEEV
Entity type:Individual
Prefix:
First Name:RUSHABH
Middle Name:SANJEEV
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8926 WOODYARD RD STE 501
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4234
Mailing Address - Country:US
Mailing Address - Phone:909-559-4815
Mailing Address - Fax:
Practice Address - Street 1:8926 WOODYARD RD STE 501
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4234
Practice Address - Country:US
Practice Address - Phone:909-559-4815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2025-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT210002489225100000X
MD30366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist