Provider Demographics
NPI:1497301923
Name:MEHTA, SHACHI (PTA)
Entity Type:Individual
Prefix:MS
First Name:SHACHI
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 150TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3629
Mailing Address - Country:US
Mailing Address - Phone:917-589-1256
Mailing Address - Fax:
Practice Address - Street 1:2223 150TH ST APT 1
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3629
Practice Address - Country:US
Practice Address - Phone:917-589-1256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007044225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant