MEDICARE: AMEE PRAFULCHANDRA MEHTA RPT

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	PT301191	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT301191	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1922329184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMEE PRAFULCHANDRA MEHTA RPT

Provider Business Mailing Address
First Line	:	6637 BULL THISTLE CT
Second Line	:
City	:	EASTVALE
State	:	CA
Zip	:	92880-9140
Country	:	US
Telephone Number	:	951-292-4012
Fax Number	:	951-292-4014

Provider Business Practice Location Address
First Line	:	308 W 6TH ST STE 202
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92882-3349
Country	:	US
Telephone Number	:	951-292-4012
Fax Number	:	951-292-4014

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

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	03/26/2026

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