Provider Demographics
NPI:1104526078
Name:CHITTUMURI, NASTASSIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:NASTASSIA
Middle Name:
Last Name:CHITTUMURI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:9934 REISTERSTOWN RD # 18E
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3945
Practice Address - Country:US
Practice Address - Phone:240-545-0507
Practice Address - Fax:410-842-2770
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050160225100000X
VA2305215604225100000X
DE225100000X
MD225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist