Provider Demographics
NPI:1881621555
Name:DESAI, ANANT B (PT)
Entity type:Individual
Prefix:MR
First Name:ANANT
Middle Name:B
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 1:2000 E CHAPMAN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4106
Mailing Address - Country:US
Mailing Address - Phone:714-870-1744
Mailing Address - Fax:714-870-1784
Practice Address - Street 1:2000 E CHAPMAN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4106
Practice Address - Country:US
Practice Address - Phone:714-870-1744
Practice Address - Fax:714-870-1784
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT11436Medicare ID - Type UnspecifiedPHYSICAL THERAPIST