| |
560 1st St, Suite D-101, Benicia, CA 94510-3295 | |
(707) 747-9977 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Clinic/center - Physical Therapy |
Location | 560 1st St, Benicia, California |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1083685333 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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225100000X | Physical Therapist | (* (Not Available)) | Secondary |
261QP2000X | Clinic/center - Physical Therapy | (* (Not Available)) | Primary |
Provider Name | Shivani Jay Mehta |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1053382309 PECOS PAC ID: 6901826791 Enrollment ID: I20051123000076 |
Mailing Address | Practice Location Address |
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560 1st St, Suite D-101, Benicia, CA 94510-3295 Ph: (707) 747-9977 | 560 1st St, Suite D-101, Benicia, CA 94510-3295 Ph: (707) 747-9977 |