Provider Demographics
NPI:1922266626
Name:GUPTA, CHIRADEEP DUTTA (PT)
Entity Type:Individual
Prefix:
First Name:CHIRADEEP
Middle Name:DUTTA
Last Name:GUPTA
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 1:334 WOODSIDE CT
Mailing Address - Street 2:APT 103
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4197
Mailing Address - Country:US
Mailing Address - Phone:906-440-5271
Mailing Address - Fax:
Practice Address - Street 1:334 WOODSIDE CT
Practice Address - Street 2:APT 103
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4197
Practice Address - Country:US
Practice Address - Phone:906-440-5271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist