Provider Demographics
NPI:1982145140
Name:DESALVO, ANNA KATRIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:KATRIN
Last Name:DESALVO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:KATRIN
Other - Last Name:GELBRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1919 W 39TH ST APT E6
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2777
Mailing Address - Country:US
Mailing Address - Phone:770-403-9717
Mailing Address - Fax:
Practice Address - Street 1:1919 W 39TH ST APT E6
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2777
Practice Address - Country:US
Practice Address - Phone:770-403-9717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3672225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist