Provider Demographics
NPI:1437434065
Name:SARDESAI, RAVINDRA
Entity Type:Individual
Prefix:
First Name:RAVINDRA
Middle Name:
Last Name:SARDESAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4453 CORNER BROOK LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2733
Mailing Address - Country:US
Mailing Address - Phone:817-896-4007
Mailing Address - Fax:
Practice Address - Street 1:4453 CORNER BROOK LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2733
Practice Address - Country:US
Practice Address - Phone:817-896-4007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112795225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist