Provider Demographics
NPI:1699283994
Name:CHITALE, SHRUTI (PTA)
Entity type:Individual
Prefix:
First Name:SHRUTI
Middle Name:
Last Name:CHITALE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 DESCANSO DR UNIT 1431
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-1844
Mailing Address - Country:US
Mailing Address - Phone:408-832-2497
Mailing Address - Fax:
Practice Address - Street 1:21020 HOMESTEAD RD STE 2
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-0240
Practice Address - Country:US
Practice Address - Phone:408-530-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-21
Last Update Date:2018-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49026225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant