Provider Demographics
NPI:1770793010
Name:GUPTA, AMITA (PT)
Entity type:Individual
Prefix:MRS
First Name:AMITA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5755 NORTHPOINT PKWY
Mailing Address - Street 2:SUITE 56
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1145
Mailing Address - Country:US
Mailing Address - Phone:678-431-1301
Mailing Address - Fax:
Practice Address - Street 1:5755 NORTHPOINT PKWY
Practice Address - Street 2:SUITE 56
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1145
Practice Address - Country:US
Practice Address - Phone:678-431-1301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005421174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist