Healthcare Provider Details

I. General information

NPI: 1023721149
Provider Name (Legal Business Name): ROCHELLE CALAYAG MITRA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13633 37TH AVE STE 1C
FLUSHING NY
11354-4562
US

IV. Provider business mailing address

5412 JUNCTION BLVD # 1F
ELMHURST NY
11373-4620
US

V. Phone/Fax

Practice location:
  • Phone: 718-961-9800
  • Fax:
Mailing address:
  • Phone: 631-469-4959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number045307
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: