Provider Demographics
NPI:1174883201
Name:SHAH, KENA PANKAJKUMAR
Entity type:Individual
Prefix:MRS
First Name:KENA
Middle Name:PANKAJKUMAR
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 MEDICAL PLAZA DR STE 150
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3255
Mailing Address - Country:US
Mailing Address - Phone:281-367-1912
Mailing Address - Fax:281-367-5101
Practice Address - Street 1:1011 MEDICAL PLAZA DR STE 150
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3255
Practice Address - Country:US
Practice Address - Phone:281-367-1912
Practice Address - Fax:281-367-5101
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1310356225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist