Basic Information
| Provider Information | |||||||||
| NPI: | 1114488905 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MEHTA | ||||||||
| FirstName: | GARIMA | ||||||||
| MiddleName: | DARSHAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37096 HARRISON CT APT 687 | ||||||||
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| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483352067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819994418 | ||||||||
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| Practice Location | |||||||||
| Address1: | 26400 W 12 MILE RD STE 25 | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480341774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485654000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2019 | ||||||||
| LastUpdateDate: | 03/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501017690 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.