Provider Demographics
NPI:1295989036
Name:GUPTA, PRIYANKA (PT)
Entity type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12951 BEL RED RD
Mailing Address - Street 2:SUITE100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2644
Mailing Address - Country:US
Mailing Address - Phone:425-435-5277
Mailing Address - Fax:425-455-2910
Practice Address - Street 1:12951 BEL RED RD
Practice Address - Street 2:SUITE100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2644
Practice Address - Country:US
Practice Address - Phone:425-435-5277
Practice Address - Fax:425-455-2910
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60028820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist