Provider Demographics
NPI:1235432345
Name:MEHTA, MANSI (PT)
Entity Type:Individual
Prefix:
First Name:MANSI
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1562 E LAKE COOK RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-2249
Mailing Address - Country:US
Mailing Address - Phone:847-243-1000
Mailing Address - Fax:847-465-9296
Practice Address - Street 1:1562-1564 LAKE COOK ROAD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090
Practice Address - Country:US
Practice Address - Phone:847-243-1000
Practice Address - Fax:847-465-9296
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist