Provider Demographics
NPI:1376958082
Name:DESAI, NEELAM SAMIT
Entity Type:Individual
Prefix:
First Name:NEELAM
Middle Name:SAMIT
Last Name:DESAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NEELAM
Other - Middle Name:SANJAY
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14420 BALLANTYNE LAKE RD
Mailing Address - Street 2:#328
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3385
Mailing Address - Country:US
Mailing Address - Phone:408-391-6584
Mailing Address - Fax:
Practice Address - Street 1:5800 OLD PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-6872
Practice Address - Country:US
Practice Address - Phone:704-365-8551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist