Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT023119 | PA |
NPI | 1104589530 |
---|---|
Provider Name | Bijal Shah |
First Address | Glenside, PA 19038-7833 |
Second Address | Glenside, PA 19038-7833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2021 |
Last Update Date | 30/10/2021 |