Basic Information
| Provider Information | |||||||||
| NPI: | 1477827053 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEHTA | ||||||||
| FirstName: | PREYAS | ||||||||
| MiddleName: | SHASHANKKUMAR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5980 W 71ST ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462781785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173880800 | ||||||||
| FaxNumber: | 3173880805 | ||||||||
| Practice Location | |||||||||
| Address1: | 5980 W 71ST ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462781785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173880800 | ||||||||
| FaxNumber: | 3173880805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/29/2012 | ||||||||
| LastUpdateDate: | 11/30/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171W00000X | 033784-1 | NY | N | Other Service Providers | Contractor | 225100000X | 40QA01711800 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 1270407 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 033784 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.