Provider Demographics
NPI:1124883608
Name:MEHTA, PAYAL SHAILESH (PT)
Entity type:Individual
Prefix:
First Name:PAYAL
Middle Name:SHAILESH
Last Name:MEHTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEHTA
Other - Middle Name:PAYAL
Other - Last Name:SHAILESH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 21150
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-4150
Mailing Address - Country:US
Mailing Address - Phone:303-546-9158
Mailing Address - Fax:303-546-9107
Practice Address - Street 1:4350 WADSWORTH BLVD STE 425
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4652
Practice Address - Country:US
Practice Address - Phone:303-564-5008
Practice Address - Fax:720-484-4329
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0019483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist