Provider Demographics
NPI:1912117037
Name:MEHTA, RUPAL (PT)
Entity Type:Individual
Prefix:MR
First Name:RUPAL
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 GARRETT RD
Mailing Address - Street 2:APT E 310
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-4472
Mailing Address - Country:US
Mailing Address - Phone:203-927-0802
Mailing Address - Fax:
Practice Address - Street 1:25420 KUYKENDAHL RD
Practice Address - Street 2:STE A100
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77375-3407
Practice Address - Country:US
Practice Address - Phone:610-565-8717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1281548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA06518Medicare ID - Type Unspecified