Provider Demographics
NPI:1255622973
Name:SHAHIWALA, RUSHI (BPT)
Entity type:Individual
Prefix:MR
First Name:RUSHI
Middle Name:
Last Name:SHAHIWALA
Suffix:
Gender:M
Credentials:BPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 AVENIDA LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-1288
Mailing Address - Country:US
Mailing Address - Phone:201-744-5549
Mailing Address - Fax:
Practice Address - Street 1:4413 AVENIDA LN
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-1288
Practice Address - Country:US
Practice Address - Phone:201-744-5549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1310649OtherTEXAS BOARD OF PHYSICAL THERAPY