Provider Demographics
NPI:1871809889
Name:SHAH, KOMAL S (RPT)
Entity type:Individual
Prefix:MRS
First Name:KOMAL
Middle Name:S
Last Name:SHAH
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 10304
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33061
Mailing Address - Country:US
Mailing Address - Phone:954-540-3858
Mailing Address - Fax:954-784-4910
Practice Address - Street 1:8304 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7308
Practice Address - Country:US
Practice Address - Phone:954-540-3858
Practice Address - Fax:954-748-4910
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 00004016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist