Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 40871 | CA |
NPI | 1104257401 |
---|---|
Provider Name | Tanvi Mehta |
First Address | Norwalk, CA 90650-1680 |
Second Address | Culver City, CA 90230-6301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2013 |
Last Update Date | 12/12/2013 |