Provider Demographics
NPI:1851316160
Name:DESIATO, JOHN V (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:V
Last Name:DESIATO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6169 S BALSAM WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3000
Mailing Address - Country:US
Mailing Address - Phone:303-948-1868
Mailing Address - Fax:303-948-1741
Practice Address - Street 1:6169 S BALSAM WAY STE 110
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123
Practice Address - Country:US
Practice Address - Phone:339-481-1868
Practice Address - Fax:303-948-1741
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0005430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52780066Medicaid
COC805758Medicare PIN