Provider Demographics
NPI:1427409606
Name:GUPTA, JYOTI (PT)
Entity Type:Individual
Prefix:
First Name:JYOTI
Middle Name:
Last Name:GUPTA
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 1:180 TURN OF RIVER RD
Mailing Address - Street 2:UNIT 3A
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1396
Mailing Address - Country:US
Mailing Address - Phone:617-749-8592
Mailing Address - Fax:
Practice Address - Street 1:122 PALMERS HILL RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2134
Practice Address - Country:US
Practice Address - Phone:203-323-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist