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General NPI Number Information
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NPI Number | 1922266626
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Entity Type | Individual
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Provider Name | CHIRADEEP DUTTA GUPTA P.T.
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Gender | Male
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 334 WOODSIDE CT APT 103
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-4197
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Country | US
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Telephone | 906-440-5271
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Fax |
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Provider Business Mailing Address
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Address Line | 334 WOODSIDE CT APT 103
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-4197
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Country | US
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Telephone | 906-440-5271
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5501011876
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License Number State | MI
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