Healthcare Provider Details

I. General information

NPI: 1326929936
Provider Name (Legal Business Name): NEELA MHATRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 EDWARD DR
ROMEOVILLE IL
60446-6507
US

IV. Provider business mailing address

110 HORIZON DR STE 301
RALEIGH NC
27615-4926
US

V. Phone/Fax

Practice location:
  • Phone: 815-439-2033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number070008390
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: