Provider Demographics
NPI:1629108790
Name:CHAKRAVARTY, RUPA (DPT, OCS)
Entity Type:Individual
Prefix:MRS
First Name:RUPA
Middle Name:
Last Name:CHAKRAVARTY
Suffix:
Gender:F
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 PEACOCK AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-4917
Mailing Address - Country:US
Mailing Address - Phone:408-747-7494
Mailing Address - Fax:
Practice Address - Street 1:1618 PEACOCK AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-4917
Practice Address - Country:US
Practice Address - Phone:408-747-7494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 29901225100000X
CA299012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic