Provider Demographics
NPI:1801956511
Name:DESAI, HERAT VIDYUT (PT)
Entity type:Individual
Prefix:
First Name:HERAT
Middle Name:VIDYUT
Last Name:DESAI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 DUNBARCAVE ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8848
Mailing Address - Country:US
Mailing Address - Phone:248-259-5980
Mailing Address - Fax:931-648-2225
Practice Address - Street 1:211 DUNBARCAVE ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8848
Practice Address - Country:US
Practice Address - Phone:248-259-5980
Practice Address - Fax:931-648-2225
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3646052OtherPTAN