Healthcare Provider Details

I. General information

NPI: 1841629854
Provider Name (Legal Business Name): SWATHI CHITTI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2013
Last Update Date: 11/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 W LAS BRISAS DR
MOUNTAIN HOUSE CA
95391-2083
US

IV. Provider business mailing address

543 W LAS BRISAS DR
MOUNTAIN HOUSE CA
95391-2083
US

V. Phone/Fax

Practice location:
  • Phone: 510-461-4519
  • Fax:
Mailing address:
  • Phone: 510-461-4519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number035040
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: