Provider Demographics
NPI:1912538489
Name:MISTRY, CHINTAN (PT)
Entity Type:Individual
Prefix:
First Name:CHINTAN
Middle Name:
Last Name:MISTRY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45521 MORNINGSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-5612
Mailing Address - Country:US
Mailing Address - Phone:248-372-1344
Mailing Address - Fax:
Practice Address - Street 1:31471 NORTHWESTERN HWY STE 1A
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2575
Practice Address - Country:US
Practice Address - Phone:248-865-9070
Practice Address - Fax:248-856-1242
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist