Provider Demographics
NPI:1285333880
Name:CHITTA, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:CHITTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3585 SW 38TH TER # 205
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-5808
Mailing Address - Country:US
Mailing Address - Phone:601-604-0410
Mailing Address - Fax:
Practice Address - Street 1:1717 N CLYDE MORRIS BLVD STE 140
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5532
Practice Address - Country:US
Practice Address - Phone:386-257-2672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL236Medicaid