Provider Demographics
NPI:1851841936
Name:MITRA-CHAKRABORTY, JHANSI (PT, MA, MHA)
Entity Type:Individual
Prefix:
First Name:JHANSI
Middle Name:
Last Name:MITRA-CHAKRABORTY
Suffix:
Gender:F
Credentials:PT, MA, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N STEPHANIE ST STE 310
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6608
Mailing Address - Country:US
Mailing Address - Phone:702-454-1162
Mailing Address - Fax:702-454-8817
Practice Address - Street 1:400 N STEPHANIE ST STE 310
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6608
Practice Address - Country:US
Practice Address - Phone:702-454-1162
Practice Address - Fax:702-454-8817
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006011485225100000X
NV5031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist