Provider Demographics
NPI:1689382491
Name:DESERTO, KATEY DIANNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATEY
Middle Name:DIANNE
Last Name:DESERTO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KATEY
Other - Middle Name:DIANNE
Other - Last Name:MERENYI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 MAYBROOK RD STE L
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HALL
Mailing Address - State:NY
Mailing Address - Zip Code:10916-2741
Mailing Address - Country:US
Mailing Address - Phone:845-636-4344
Mailing Address - Fax:
Practice Address - Street 1:20 WALNUT ST STE B
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-2261
Practice Address - Country:US
Practice Address - Phone:845-457-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist