Provider Demographics
NPI:1487192837
Name:GUPTA, RICHA
Entity Type:Individual
Prefix:
First Name:RICHA
Middle Name:
Last Name:GUPTA
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 1:1840 NATIONAL AVE
Mailing Address - Street 2:APT 206
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-3362
Mailing Address - Country:US
Mailing Address - Phone:317-332-2038
Mailing Address - Fax:
Practice Address - Street 1:1311 N SHADELAND AVE
Practice Address - Street 2:SUITE E-J
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3660
Practice Address - Country:US
Practice Address - Phone:317-352-0933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012296A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist