MEDICARE: MRS. ROOPA M DESAI PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	003089	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00149727	OTHER	GA	RAILROAD MEDICARE PIN
2	DC1303	OTHER	GA	RAILROAD MEDICARE GRP ID

General Provider Information

NPI Number	:	1548266760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROOPA M DESAI PT

Provider Business Mailing Address
First Line	:	1561 JANMAR RD
Second Line	:	STE B
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-5693
Country	:	US
Telephone Number	:	770-972-8536
Fax Number	:	770-736-9629

Provider Business Practice Location Address
First Line	:	1561 JANMAR RD
Second Line	:	STE B
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-5693
Country	:	US
Telephone Number	:	770-972-8536
Fax Number	:	770-736-9629

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/09/2007

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