Provider Demographics
NPI:1770938458
Name:MEHTA, PATHIK (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:PATHIK
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 KIRTS BLVD
Mailing Address - Street 2:APT 214
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4808
Mailing Address - Country:US
Mailing Address - Phone:313-804-0151
Mailing Address - Fax:
Practice Address - Street 1:30250 JOHN R RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-5205
Practice Address - Country:US
Practice Address - Phone:586-421-5174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist