Provider Demographics
NPI:1578760369
Name:AHYA, CHAITALI (DPT, OCS, CMP)
Entity Type:Individual
Prefix:DR
First Name:CHAITALI
Middle Name:
Last Name:AHYA
Suffix:
Gender:F
Credentials:DPT, OCS, CMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5535 MOREHOUSE DR
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1710
Mailing Address - Country:US
Mailing Address - Phone:858-651-4709
Mailing Address - Fax:858-651-5375
Practice Address - Street 1:5535 MOREHOUSE DR
Practice Address - Street 2:SUITE 270
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1710
Practice Address - Country:US
Practice Address - Phone:858-651-4709
Practice Address - Fax:858-651-5375
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist