Provider Demographics
NPI:1982843272
Name:MARVANIA, DEESHA M (PT)
Entity Type:Individual
Prefix:MS
First Name:DEESHA
Middle Name:M
Last Name:MARVANIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DEESHA
Other - Middle Name:J
Other - Last Name:GONDALIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 STRAWBERRY HILL AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2536
Mailing Address - Country:US
Mailing Address - Phone:203-548-0475
Mailing Address - Fax:203-614-8746
Practice Address - Street 1:125 STRAWBERRY HILL AVE STE 102
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902
Practice Address - Country:US
Practice Address - Phone:203-548-0475
Practice Address - Fax:203-614-8746
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10471225100000X
NY030301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist