Provider Demographics
NPI:1326404161
Name:MODI, DEVANSHI (PT,CMP, CERT MDT)
Entity Type:Individual
Prefix:
First Name:DEVANSHI
Middle Name:
Last Name:MODI
Suffix:
Gender:F
Credentials:PT,CMP, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 ROUTE 18 NORTH STE 110 BLDG B
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3722
Mailing Address - Country:US
Mailing Address - Phone:551-208-3234
Mailing Address - Fax:
Practice Address - Street 1:646 ROUTE 18 NORTH
Practice Address - Street 2:SUITE 110, BUILDING B
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:551-208-3234
Practice Address - Fax:855-282-5632
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-09
Last Update Date:2022-03-04
Deactivation Date:2018-05-14
Deactivation Code:
Reactivation Date:2018-08-22
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01732700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist