Provider Demographics
NPI:1669806154
Name:CHOUBAL, MITALEE SUSHEEL (DPT)
Entity type:Individual
Prefix:MISS
First Name:MITALEE
Middle Name:SUSHEEL
Last Name:CHOUBAL
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 DARDANELLI LN STE 1F
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1421
Mailing Address - Country:US
Mailing Address - Phone:408-378-2240
Mailing Address - Fax:
Practice Address - Street 1:360 DARDANELLI LN STE 1F
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1421
Practice Address - Country:US
Practice Address - Phone:408-378-2240
Practice Address - Fax:408-378-2256
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
CA292646261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy