Provider Demographics
NPI:1427570050
Name:CHANDAN, ESHITA X (PT)
Entity Type:Individual
Prefix:MS
First Name:ESHITA
Middle Name:
Last Name:CHANDAN
Suffix:X
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 1:1301 E BIDWELL ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3565
Mailing Address - Country:US
Mailing Address - Phone:916-983-5915
Mailing Address - Fax:916-983-5906
Practice Address - Street 1:3975 MISSOURI FLAT RD STE 220
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5251
Practice Address - Country:US
Practice Address - Phone:530-626-4734
Practice Address - Fax:916-983-5906
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA293142OtherCA STATE PT BOARD