Provider Demographics
NPI:1518447945
Name:MEHTA, SHILPA (PT)
Entity Type:Individual
Prefix:
First Name:SHILPA
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 1:2669 WHITNEY PL
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3954
Mailing Address - Country:US
Mailing Address - Phone:810-385-4978
Mailing Address - Fax:
Practice Address - Street 1:4190 24TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3884
Practice Address - Country:US
Practice Address - Phone:810-216-1802
Practice Address - Fax:810-216-1857
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005154261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy