Basic Information
| Provider Information | |||||||||
| NPI: | 1578793519 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | RAJVEE | ||||||||
| MiddleName: | ASHOK | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 910 COUNTRY CLUB DR | ||||||||
| Address2: | |||||||||
| City: | BLOOMSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178158535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3123072954 | ||||||||
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| Practice Location | |||||||||
| Address1: | 845 WATER ST | ||||||||
| Address2: | |||||||||
| City: | NORTHUMBERLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178571243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704733912 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2009 | ||||||||
| LastUpdateDate: | 07/15/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT022656 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.