Provider Demographics
NPI:1255860748
Name:DESAI, KINJAL JAYMIN (PT)
Entity Type:Individual
Prefix:
First Name:KINJAL
Middle Name:JAYMIN
Last Name:DESAI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 SUMMERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-1821
Mailing Address - Country:US
Mailing Address - Phone:561-697-8800
Mailing Address - Fax:561-697-3372
Practice Address - Street 1:19300 BROAD SHORE WALK
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-2106
Practice Address - Country:US
Practice Address - Phone:561-697-8800
Practice Address - Fax:561-697-3372
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32576225100000X
TX1354983208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty