Provider Demographics
NPI:1457799801
Name:DESAI, SEJAL (DPT)
Entity Type:Individual
Prefix:
First Name:SEJAL
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 LICK MILL BLVD
Mailing Address - Street 2:#447
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-4308
Mailing Address - Country:US
Mailing Address - Phone:512-484-7802
Mailing Address - Fax:
Practice Address - Street 1:15251 NATIONAL AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2400
Practice Address - Country:US
Practice Address - Phone:408-356-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist