Provider Demographics
NPI:1770802050
Name:CHITRE, PRAJAKTA Y (MPT)
Entity type:Individual
Prefix:MRS
First Name:PRAJAKTA
Middle Name:Y
Last Name:CHITRE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1667 S MAIN ST
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-6263
Mailing Address - Country:US
Mailing Address - Phone:661-645-8002
Mailing Address - Fax:
Practice Address - Street 1:1667 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6263
Practice Address - Country:US
Practice Address - Phone:661-645-8002
Practice Address - Fax:408-945-8004
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT300112251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist