Individual provider Active NPI

Mitalee Susheel Choubal, D.P.T

  • Physical Therapy Clinic/Center
  • Los Gatos, CA
National Provider Identifier
1669806154
Registry record updated Mar 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
292646 Issued in CA
Practice address
360 Dardanelli LN Ste 1F
Los Gatos, CA 95032-1421
Phone
(408) 378-2240
Fax
(408) 378-2256
NPI assigned
Sep 3, 2013
Last updated
Mar 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU
Physical Therapy Clinic/Center 261QP2000X 292646 CA Primary

Addresses

Primary practice location

360 Dardanelli LN Ste 1F
Los Gatos, CA 95032-1421

Mailing address

360 Dardanelli LN Ste 1F
Los Gatos, CA 95032-1421
Phone (408) 378-2240

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171211002796 CA Practitioner - Physical Therapist in Private Practice 5496979130 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2013
Medicare assignment
May accept Medicare assignment
Group practices
Select Cal Physical Therapy PCGroup PAC ID 4789070699, 162 clinicians
B.E.S.T. Physical Therapy a Prof CorpGroup PAC ID 7719970748, 7 clinicians

Practice addresses (Care Compare)

360 Dardanelli LN
Suite 1F
Los Gatos, CA 95032-1421
Phone (408) 378-2240

6155 Almaden Expy
Suite 150
San Jose, CA 95120-2781
Phone (408) 268-2225

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
035431NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Select Cal Physical Therapy PC Physical Therapist CurrentSince May 27, 2022 Accepting new patients
Select Cal Physical Therapy PC Physical Therapist Current Accepting new patients
Select Cal Physical Therapy PC Physical Therapist CurrentSince May 27, 2022 Accepting new patients

Locations

360 Dardanelli Ln
Ste 1F
Los Gatos, CA 95032
Phone (408) 374-8823

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743206400000",
    "number": "1669806154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 DARDANELLI LN STE 1F",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950321421",
            "telephone_number": "408-378-2240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 DARDANELLI LN STE 1F",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950321421",
            "telephone_number": "408-378-2240",
            "fax_number": "408-378-2256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHOUBAL",
        "first_name": "MITALEE",
        "middle_name": "SUSHEEL",
        "name_prefix": "Miss",
        "credential": "D.P.T",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-03",
        "last_updated": "2025-03-29",
        "certification_date": "2025-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "292646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Gatos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.