Provider Demographics
NPI:1013374677
Name:MEHTA, HETALBEN ASHISH
Entity Type:Individual
Prefix:
First Name:HETALBEN
Middle Name:ASHISH
Last Name:MEHTA
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 1:289 WOODSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6702
Mailing Address - Country:US
Mailing Address - Phone:224-436-4489
Mailing Address - Fax:
Practice Address - Street 1:289 WOODSTONE CIR
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6702
Practice Address - Country:US
Practice Address - Phone:224-436-4489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030661225100000X
IL070021972225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist