Provider Demographics
NPI:1679753487
Name:MEHTA, NEEMA SHAH (PT)
Entity type:Individual
Prefix:
First Name:NEEMA
Middle Name:SHAH
Last Name:MEHTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NEEMA
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:4404 HUGH HOWELL RD
Practice Address - Street 2:SUITE 18
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4916
Practice Address - Country:US
Practice Address - Phone:770-493-5543
Practice Address - Fax:770-493-5549
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7873225100000X
2251S0007X, 2251X0800X
GAPT10020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic