Healthcare Provider Details

I. General information

NPI: 1699439414
Provider Name (Legal Business Name): CHAKRA PHYSICAL THERAPY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 JACKIE LN
BALDWIN NY
11510-4511
US

IV. Provider business mailing address

745 JACKIE LN
BALDWIN NY
11510-4511
US

V. Phone/Fax

Practice location:
  • Phone: 516-376-3293
  • Fax:
Mailing address:
  • Phone: 516-376-3293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. FREYA TARAPORE
Title or Position: PRESIDENT/SECRETARY
Credential:
Phone: 516-376-3293