Healthcare Provider Details

I. General information

NPI: 1265093751
Provider Name (Legal Business Name): MAITRI VIVEK MEHTA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 E BROADWAY RD STE 6
MESA AZ
85208-1156
US

IV. Provider business mailing address

9455 E RAINTREE DR UNIT 1043
SCOTTSDALE AZ
85260-7744
US

V. Phone/Fax

Practice location:
  • Phone: 480-432-3694
  • Fax:
Mailing address:
  • Phone: 812-706-9066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberLPT-30647
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: