Healthcare Provider Details

I. General information

NPI: 1619361292
Provider Name (Legal Business Name): TIRUPATHI CHINDAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 DOGTOWN RD ENVOY AT THE MEADOWS
GOOCHLAND VA
23063-2424
US

IV. Provider business mailing address

8731 KILPECK CT
HENRICO VA
23294-5131
US

V. Phone/Fax

Practice location:
  • Phone: 804-556-4418
  • Fax:
Mailing address:
  • Phone: 909-800-5350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305206688
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: