Provider Demographics
NPI:1588851281
Name:DESAI, NIYATI (DPT)
Entity Type:Individual
Prefix:
First Name:NIYATI
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 BRIARCLIFF RD NE
Mailing Address - Street 2:APT A-1
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2648
Mailing Address - Country:US
Mailing Address - Phone:919-824-5133
Mailing Address - Fax:
Practice Address - Street 1:335 UPPER RIVERDALE RD STE B10
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1071
Practice Address - Country:US
Practice Address - Phone:770-907-4753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist