Provider Demographics
NPI:1811465917
Name:CHITTALURI, LAXMI (PT)
Entity type:Individual
Prefix:
First Name:LAXMI
Middle Name:
Last Name:CHITTALURI
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 1:2215 WOODRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2600
Mailing Address - Country:US
Mailing Address - Phone:310-910-5120
Mailing Address - Fax:
Practice Address - Street 1:340 NORTHLAKE DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1251
Practice Address - Country:US
Practice Address - Phone:408-556-2128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist