Provider Demographics
NPI:1063833150
Name:KANANI, CHITRA (PT)
Entity Type:Individual
Prefix:
First Name:CHITRA
Middle Name:
Last Name:KANANI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-1900
Mailing Address - Country:US
Mailing Address - Phone:201-875-6691
Mailing Address - Fax:201-455-6691
Practice Address - Street 1:665 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002
Practice Address - Country:US
Practice Address - Phone:201-875-6691
Practice Address - Fax:201-455-6691
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01534500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist