Provider Demographics
NPI:1184399735
Name:BATHLA, CHAITANYA (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:CHAITANYA
Middle Name:
Last Name:BATHLA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7702 34TH AVE APT B44
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-2255
Mailing Address - Country:US
Mailing Address - Phone:408-507-6508
Mailing Address - Fax:866-605-5654
Practice Address - Street 1:7702 34TH AVE APT B44
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-2255
Practice Address - Country:US
Practice Address - Phone:408-507-6508
Practice Address - Fax:866-605-5654
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046871208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation