Provider Demographics
NPI:1851116560
Name:RUPA BENOY CHAKRAVARTY
Entity type:Organization
Organization Name:RUPA BENOY CHAKRAVARTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUPA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKRAVARTY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, OCS
Authorized Official - Phone:408-614-5370
Mailing Address - Street 1:1618 PEACOCK AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-4917
Mailing Address - Country:US
Mailing Address - Phone:408-614-5370
Mailing Address - Fax:408-503-6176
Practice Address - Street 1:621 E CAMPBELL AVE STE 10A
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2135
Practice Address - Country:US
Practice Address - Phone:408-202-0941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty