=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669806154
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MITALEE SUSHEEL CHOUBAL D.P.T
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2013
-----------------------------------------------------
Last Update Date | 03/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 360 DARDANELLI LN STE 1F
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-1421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-378-2240
-----------------------------------------------------
Fax | 408-378-2256
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 360 DARDANELLI LN STE 1F
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-1421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-378-2240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 292646
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------