Healthcare Provider Details

I. General information

NPI: 1851487466
Provider Name (Legal Business Name): CHANDRESH R MEHTA PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VAMC-GECU 50 IRVING ST, NW
WASHINGTON DC
20422
US

IV. Provider business mailing address

8505 OAK CHASE CIRCLE
FAIRFAX STATION VA
22039
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-9574
  • Fax: 202-745-2283
Mailing address:
  • Phone: 703-690-9442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305002531
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: