Provider Demographics
NPI:1003138421
Name:DESAULNIERS, CHARINA MONTON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHARINA
Middle Name:MONTON
Last Name:DESAULNIERS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19376 SW 65TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33332-3362
Mailing Address - Country:US
Mailing Address - Phone:954-252-2705
Mailing Address - Fax:954-252-0524
Practice Address - Street 1:19376 SW 65TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33332-3362
Practice Address - Country:US
Practice Address - Phone:954-252-2705
Practice Address - Fax:954-252-0524
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19506225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist