Provider Demographics
NPI:1356611685
Name:DURISETY, ANJANI
Entity type:Individual
Prefix:MISS
First Name:ANJANI
Middle Name:
Last Name:DURISETY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 MAYTEN WAY
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-7630
Mailing Address - Country:US
Mailing Address - Phone:408-406-7046
Mailing Address - Fax:
Practice Address - Street 1:437 MAYTEN WAY
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-7630
Practice Address - Country:US
Practice Address - Phone:408-406-7046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40582225100000X
NY032427225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist