Provider Demographics
NPI:1811210115
Name:DESAI, PANKTI J (PT)
Entity Type:Individual
Prefix:MISS
First Name:PANKTI
Middle Name:J
Last Name:DESAI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10940 RAVEN RIDGE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6610
Mailing Address - Country:US
Mailing Address - Phone:919-518-0420
Mailing Address - Fax:919-518-0421
Practice Address - Street 1:10940 RAVEN RIDGE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6610
Practice Address - Country:US
Practice Address - Phone:919-518-0420
Practice Address - Fax:919-518-0421
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12537174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist