Healthcare Provider Details

I. General information

NPI: 1841865862
Provider Name (Legal Business Name): CARI DESROSIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 RETREAT DR
NAPLES FL
34110-7925
US

IV. Provider business mailing address

24216 420TH AVE
DETROIT LAKES MN
56501-8113
US

V. Phone/Fax

Practice location:
  • Phone: 888-539-4842
  • Fax:
Mailing address:
  • Phone: 218-290-0565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA31110
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number31110
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: