Provider Demographics
NPI:1891830832
Name:BAWEJA CHANDRA, ADITI (DPT)
Entity type:Individual
Prefix:MRS
First Name:ADITI
Middle Name:
Last Name:BAWEJA CHANDRA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1833
Mailing Address - Country:US
Mailing Address - Phone:508-358-4900
Mailing Address - Fax:508-358-3525
Practice Address - Street 1:524 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-1833
Practice Address - Country:US
Practice Address - Phone:508-358-4900
Practice Address - Fax:508-358-3525
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA90233OtherHPHC
MAY68711OtherBLUE CROSS MA
MA498788OtherTUFTS
MA00195OtherMEDICARE PTAN
MA4401395OtherCIGNA ORTHONET