Provider Demographics
NPI:1053382309
Name:MEHTA, SHIVANI (MPT)
Entity type:Individual
Prefix:
First Name:SHIVANI
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SHIVANI
Other - Middle Name:
Other - Last Name:DAMANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:560 1ST ST
Mailing Address - Street 2:SUITE D-101
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3295
Mailing Address - Country:US
Mailing Address - Phone:707-747-9977
Mailing Address - Fax:
Practice Address - Street 1:560 1ST ST
Practice Address - Street 2:SUITE D-101
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3295
Practice Address - Country:US
Practice Address - Phone:707-747-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT258511OtherMEDICARE - PART B
CA0PT258511OtherMEDICARE - PART B
CA0PT258510Medicare ID - Type UnspecifiedMEDICARE PART B