Provider Demographics
NPI:1558787861
Name:DUTTA, GEETANJALI GERA (PHD, PT)
Entity Type:Individual
Prefix:DR
First Name:GEETANJALI
Middle Name:GERA
Last Name:DUTTA
Suffix:
Gender:F
Credentials:PHD, PT
Other - Prefix:DR
Other - First Name:GEETANJALI
Other - Middle Name:
Other - Last Name:GERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, PT
Mailing Address - Street 1:3270 LIBERTY RD S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302
Mailing Address - Country:US
Mailing Address - Phone:503-371-0779
Mailing Address - Fax:503-371-0886
Practice Address - Street 1:3270 LIBERTY RD S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302
Practice Address - Country:US
Practice Address - Phone:503-371-0779
Practice Address - Fax:503-371-0886
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist