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General NPI Number Information
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NPI Number | 1104257401
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Entity Type | Individual
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Provider Name | TANVI MEHTA PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 12/12/2013
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Last Update Date | 12/12/2013
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Provider Practice Location Address
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Address Line | 6820 S CENTINELA AVE
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City | CULVER CITY
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State | CA
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Zip | 90230-6301
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Country | US
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Telephone | 714-220-7992
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Fax |
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Provider Business Mailing Address
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Address Line | 11134 PIONEER BLVD
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City | NORWALK
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State | CA
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Zip | 90650-1680
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Country | US
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Telephone | 714-220-7992
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 40871
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License Number State | CA
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