Provider Demographics
NPI:1295137230
Name:CHAKRABORTY, SHIRAJ (PT, DPT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:SHIRAJ
Middle Name:
Last Name:CHAKRABORTY
Suffix:
Gender:M
Credentials:PT, DPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 E LAMBERT RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-4370
Mailing Address - Country:US
Mailing Address - Phone:714-256-5074
Mailing Address - Fax:714-256-0770
Practice Address - Street 1:239 E KATELLA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-4853
Practice Address - Country:US
Practice Address - Phone:714-538-0025
Practice Address - Fax:714-538-3128
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41580225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist