Healthcare Provider Details

I. General information

NPI: 1992569487
Provider Name (Legal Business Name): GOOD JOB PEDIATRIC PT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
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 Number
License Number StateNULL

VIII. Authorized Official

Name: MISS MAITRI VIVEK MEHTA
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 480-432-3694