Provider Demographics
NPI:1922148337
Name:DEVACAANTHAN, AMBIKA (MSPT)
Entity Type:Individual
Prefix:MS
First Name:AMBIKA
Middle Name:
Last Name:DEVACAANTHAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 W 82ND ST
Mailing Address - Street 2:APT 2A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5335
Mailing Address - Country:US
Mailing Address - Phone:954-684-8234
Mailing Address - Fax:
Practice Address - Street 1:317 W 82ND ST
Practice Address - Street 2:APT 2A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5335
Practice Address - Country:US
Practice Address - Phone:954-684-8234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21181225100000X
NYPT 030235225100000X
NY22 030235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist