Healthcare Provider Details

I. General information

NPI: 1801199344
Provider Name (Legal Business Name): MONAL DESAI MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 RIDGEWOOD RD
ELK GROVE VLG IL
60007-1412
US

IV. Provider business mailing address

26 RIDGEWOOD RD
ELK GROVE VLG IL
60007-1412
US

V. Phone/Fax

Practice location:
  • Phone: 849-312-2527
  • Fax:
Mailing address:
  • Phone: 849-312-2527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070015847
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: