Healthcare Provider Details

I. General information

NPI: 1457799801
Provider Name (Legal Business Name): SEJAL DESAI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15251 NATIONAL AVE SUITE 203
LOS GATOS CA
95032-2400
US

IV. Provider business mailing address

3901 LICK MILL BLVD #447
SANTA CLARA CA
95054-4308
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-1990
  • Fax:
Mailing address:
  • Phone: 512-484-7802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: