Provider Demographics
NPI:1508333931
Name:MEHTA, SHRUTI (DPT)
Entity Type:Individual
Prefix:
First Name:SHRUTI
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E MARKET ST STE B
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4171
Mailing Address - Country:US
Mailing Address - Phone:703-443-6700
Mailing Address - Fax:703-443-6702
Practice Address - Street 1:525 E MARKET ST STE B
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4171
Practice Address - Country:US
Practice Address - Phone:703-443-6700
Practice Address - Fax:703-443-6702
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25770225100000X
VA2305213870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist