Healthcare Provider Details

I. General information

NPI: 1023933405
Provider Name (Legal Business Name): KINJALKUMARI DEVENDRASINH CHHASATIYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 WILLARD AVE STE 1
NEWINGTON CT
06111-2630
US

IV. Provider business mailing address

2089 BERLIN TPKE
NEWINGTON CT
06111-3217
US

V. Phone/Fax

Practice location:
  • Phone: 860-665-8265
  • Fax:
Mailing address:
  • Phone: 860-984-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15549
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: