Provider Demographics
NPI:1336538651
Name:DAVE, CHIRAGKUMAR (PTA)
Entity Type:Individual
Prefix:
First Name:CHIRAGKUMAR
Middle Name:
Last Name:DAVE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4164 SABIO CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4624
Mailing Address - Country:US
Mailing Address - Phone:817-808-8008
Mailing Address - Fax:
Practice Address - Street 1:2400 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5332
Practice Address - Country:US
Practice Address - Phone:510-793-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10364225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant