Provider Demographics
NPI:1164969002
Name:MEHTA, VAIBHAVI HASIT (PT)
Entity Type:Individual
Prefix:
First Name:VAIBHAVI
Middle Name:HASIT
Last Name:MEHTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VAIBHAVI
Other - Middle Name:P
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 4058
Mailing Address - Street 2:APT# 202
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-4058
Mailing Address - Country:US
Mailing Address - Phone:410-315-9080
Mailing Address - Fax:
Practice Address - Street 1:6936 ANDERSONS WAY
Practice Address - Street 2:APT# 202
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-6950
Practice Address - Country:US
Practice Address - Phone:980-333-8876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26296225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist