Healthcare Provider Details

I. General information

NPI: 1770802050
Provider Name (Legal Business Name): PRAJAKTA Y CHITRE MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 S MAIN ST
MILPITAS CA
95035-6263
US

IV. Provider business mailing address

1667 S MAIN ST BUILDING 4
MILPITAS CA
95035-6263
US

V. Phone/Fax

Practice location:
  • Phone: 661-645-8002
  • Fax: 408-945-8004
Mailing address:
  • Phone: 661-645-8002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT30011
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT30011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: