Provider Demographics
NPI:1053960443
Name:CHAKRABORTY, AYAN KUMAR (DPT)
Entity type:Individual
Prefix:
First Name:AYAN
Middle Name:KUMAR
Last Name:CHAKRABORTY
Suffix:
Gender:M
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:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:9900 S INTERSTATE 35 STE P375
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-3885
Practice Address - Country:US
Practice Address - Phone:512-580-3006
Practice Address - Fax:512-765-9192
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1111112225100000X
TX1338768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist