Provider Demographics
NPI:1083807556
Name:DESAI, ANKUR ASHOK (PT)
Entity Type:Individual
Prefix:MR
First Name:ANKUR
Middle Name:ASHOK
Last Name:DESAI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 MORHOUSE ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49053-8712
Mailing Address - Country:US
Mailing Address - Phone:269-665-9474
Mailing Address - Fax:
Practice Address - Street 1:290 MORHOUSE ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:MI
Practice Address - Zip Code:49053-8712
Practice Address - Country:US
Practice Address - Phone:269-665-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012123225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist