Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2306604183 | VA |
NPI | 1013435247 |
---|---|
Provider Name | Neelesh N. Shah |
First Address | Roanoke, VA 24016-5204 |
Second Address | Roanoke, VA 24016-5204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2017 |
Last Update Date | 08/09/2017 |