Provider Demographics
NPI:1386766780
Name:MITTAL, CHITRA KOTHARI (PT, MHS,OCS)
Entity type:Individual
Prefix:
First Name:CHITRA
Middle Name:KOTHARI
Last Name:MITTAL
Suffix:
Gender:F
Credentials:PT, MHS,OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CHRISTOPHER COLUMBUS DR
Mailing Address - Street 2:STE 300
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-5568
Mailing Address - Country:US
Mailing Address - Phone:201-366-1115
Mailing Address - Fax:
Practice Address - Street 1:115 CHRISTOPHER COLUMBUS DR STE 300
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3551
Practice Address - Country:US
Practice Address - Phone:201-366-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012215225100000X
MA17880225100000X
NY0321482251X0800X
2251X0800X
NJ40QA013175002251X0800X
IN05008574A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist