Provider Demographics
NPI:1275038143
Name:CHORATH, DEEPTI ROSE
Entity Type:Individual
Prefix:MRS
First Name:DEEPTI
Middle Name:ROSE
Last Name:CHORATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9045 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-1803
Mailing Address - Country:US
Mailing Address - Phone:284-982-5453
Mailing Address - Fax:
Practice Address - Street 1:33300 UTICA RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-2017
Practice Address - Country:US
Practice Address - Phone:586-294-3095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-24
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015080261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy