MEDICARE: DR. CHAITALI AHYA DPT, OCS, CMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	33567	CA

General Provider Information

NPI Number	:	1578760369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAITALI AHYA DPT, OCS, CMP

Provider Business Mailing Address
First Line	:	5535 MOREHOUSE DR
Second Line	:	SUITE 270
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1710
Country	:	US
Telephone Number	:	858-651-4709
Fax Number	:	858-651-5375

Provider Business Practice Location Address
First Line	:	5535 MOREHOUSE DR
Second Line	:	SUITE 270
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1710
Country	:	US
Telephone Number	:	858-651-4709
Fax Number	:	858-651-5375

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	01/07/2013

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