Healthcare Provider Details

I. General information

NPI: 1235687609
Provider Name (Legal Business Name): PUJA DESAI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9475 ROOSEVELT BLVD
PHILADELPHIA PA
19114-2212
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 215-464-6200
  • Fax: 215-464-9834
Mailing address:
  • Phone: 630-296-2223
  • Fax: 630-759-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT025433
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: