Provider Demographics
NPI:1558570663
Name:PERSAUD, GAITRI (PTA)
Entity Type:Individual
Prefix:MISS
First Name:GAITRI
Middle Name:
Last Name:PERSAUD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 NW 68TH AVE
Mailing Address - Street 2:#505
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-7585
Mailing Address - Country:US
Mailing Address - Phone:954-918-5344
Mailing Address - Fax:
Practice Address - Street 1:1191 E NEWPORT CENTER DR
Practice Address - Street 2:PENT HOUSE J
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-7715
Practice Address - Country:US
Practice Address - Phone:954-379-1066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20424251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA20424OtherPHYSICAL THERAPY ASSISTAN