Provider Demographics
NPI:1992569487
Name:GOOD JOB PEDIATRIC PT LLC
Entity type:Organization
Organization Name:GOOD JOB PEDIATRIC PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:MAITRI
Authorized Official - Middle Name:VIVEK
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:812-706-9066
Mailing Address - Street 1:9455 E RAINTREE DR UNIT 1043
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-7744
Mailing Address - Country:US
Mailing Address - Phone:812-706-9066
Mailing Address - Fax:
Practice Address - Street 1:2500 S POWER RD STE 126-2
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-6686
Practice Address - Country:US
Practice Address - Phone:480-432-3694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy