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General NPI Number Information
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NPI Number | 1003254392
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Entity Type | Organization
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Legal Business Name | TINY INFANT TO ADULT THERAPIES
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Dates
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Enumeration Date | 06/07/2013
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Last Update Date | 06/07/2013
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Provider Practice Location Address
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Address Line | 1667 S MAIN ST
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City | MILPITAS
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State | CA
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Zip | 95035-6263
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Country | US
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Telephone | 408-945-8002
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Fax | 408-945-8004
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Provider Business Mailing Address
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Address Line | 1667 S MAIN ST
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City | MILPITAS
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State | CA
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Zip | 95035-6263
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Country | US
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Telephone | 408-945-8002
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Fax | 408-945-8004
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Authorized Official
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Title or Position | OWNER / PHYSICAL THERAPIST
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Name | MRS. PRAJAKTA Y CHITRE
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Credential | MPT
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Telephone | 661-645-8002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 30011
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License Number State | CA
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