Provider Demographics
NPI:1275059594
Name:MEHTA, DEVANSHI KIRTEN
Entity Type:Individual
Prefix:
First Name:DEVANSHI
Middle Name:KIRTEN
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 1:420 EBONY TREE AVE
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4478
Mailing Address - Country:US
Mailing Address - Phone:848-219-7695
Mailing Address - Fax:
Practice Address - Street 1:650 WANTAGH AVE STE 2
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-5390
Practice Address - Country:US
Practice Address - Phone:516-520-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist