Healthcare Provider Details

I. General information

NPI: 1841746179
Provider Name (Legal Business Name): SWATI GUPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 TRUMPETER PL
SAN JOSE CA
95131-3594
US

IV. Provider business mailing address

547 E CELEBRATION WAY
SOUTH PLAINFIELD NJ
07080-5601
US

V. Phone/Fax

Practice location:
  • Phone: 469-585-9695
  • Fax:
Mailing address:
  • Phone: 469-585-9695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number302296
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA10624900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: