MEDICARE: MR. MANOJ G. MEHTA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1039170	TX

General Provider Information

NPI Number	:	1902171432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MANOJ G. MEHTA PT

Provider Business Mailing Address
First Line	:	PO BOX 742685
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77274-2685
Country	:	US
Telephone Number	:	713-270-5375
Fax Number	:	713-270-5718

Provider Business Practice Location Address
First Line	:	6100 CORPORATE DR
Second Line	:	SUITE 270
City	:	HOUSTON
State	:	TX
Zip	:	77036-3419
Country	:	US
Telephone Number	:	713-270-5375
Fax Number	:	713-270-5718

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2012
Last Update Date	:	03/16/2012

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