Provider Demographics
NPI:1235751819
Name:DESWAL, ANANYA (DPT)
Entity Type:Individual
Prefix:
First Name:ANANYA
Middle Name:
Last Name:DESWAL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4339 E MORADA LN STE 150
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-1634
Mailing Address - Country:US
Mailing Address - Phone:209-888-6346
Mailing Address - Fax:209-478-4939
Practice Address - Street 1:4339 E MORADA LN STE 150
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-1634
Practice Address - Country:US
Practice Address - Phone:209-888-6346
Practice Address - Fax:209-478-4939
Is Sole Proprietor?:No
Enumeration Date:2020-05-17
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist