Provider Demographics
NPI:1063955201
Name:KESARA, SHAILAJA (MSPT)
Entity type:Individual
Prefix:
First Name:SHAILAJA
Middle Name:
Last Name:KESARA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 SARATOGA LN
Mailing Address - Street 2:
Mailing Address - City:MONROE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3813
Mailing Address - Country:US
Mailing Address - Phone:518-334-2703
Mailing Address - Fax:
Practice Address - Street 1:62 SARATOGA LN
Practice Address - Street 2:
Practice Address - City:MONROE TWP
Practice Address - State:NJ
Practice Address - Zip Code:08831-3813
Practice Address - Country:US
Practice Address - Phone:518-334-2703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01697900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist