Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 5501015156 | MI |
Y | 225100000X | Physical Therapist | J10002755 | DE |
N | 2251G0304X | Physical Therapist - Geriatrics | J10002755 | DE |
NPI | 1366761132 |
---|---|
Provider Name | Radhika A Mehta |
First Address | Bear, DE 19701-5308 |
Second Address | Newark, DE 19713-2068 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2010 |
Last Update Date | 19/04/2019 |