Provider Demographics
NPI:1578677183
Name:KASARI-DESULME, MONICA CRISTINA (PT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:CRISTINA
Last Name:KASARI-DESULME
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 1:1702 UNIVERSITY DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4940
Mailing Address - Country:US
Mailing Address - Phone:701-364-4999
Mailing Address - Fax:701-364-8476
Practice Address - Street 1:4289 UGSTAD RD
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-3615
Practice Address - Country:US
Practice Address - Phone:218-786-3100
Practice Address - Fax:218-576-0779
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5556225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN83453AOtherBCBS
MN116637900Medicaid