Provider Demographics
NPI:1902171432
Name:MEHTA, MANOJ G (PT)
Entity Type:Individual
Prefix:MR
First Name:MANOJ
Middle Name:G
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:PO BOX 742685
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77274-2685
Mailing Address - Country:US
Mailing Address - Phone:713-270-5375
Mailing Address - Fax:713-270-5718
Practice Address - Street 1:6100 CORPORATE DR
Practice Address - Street 2:SUITE 270
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3419
Practice Address - Country:US
Practice Address - Phone:713-270-5375
Practice Address - Fax:713-270-5718
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1039170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist