Provider Demographics
NPI:1609403005
Name:MEHTA, HETAL (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:HETAL
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 INDIAN PEAKS TRL W
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-9316
Mailing Address - Country:US
Mailing Address - Phone:303-378-8968
Mailing Address - Fax:
Practice Address - Street 1:5495 ARAPAHOE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1200
Practice Address - Country:US
Practice Address - Phone:303-544-3678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7922225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist