Healthcare Provider Details

I. General information

NPI: 1316328073
Provider Name (Legal Business Name): DEVEE SRESTHADATTA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WESTERVILLE PLZ
WESTERVILLE OH
43081-2882
US

IV. Provider business mailing address

625 ENTERPRISE DR
OAK BROOK IL
60523-8813
US

V. Phone/Fax

Practice location:
  • Phone: 614-494-0140
  • Fax: 614-494-0141
Mailing address:
  • Phone: 630-575-1916
  • Fax: 630-928-5016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.014066
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: