Provider Demographics
NPI:1285085944
Name:DESAI, NIKITA (PT, DPT)
Entity type:Individual
Prefix:
First Name:NIKITA
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LAS BALAS
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-4124
Mailing Address - Country:US
Mailing Address - Phone:213-675-0244
Mailing Address - Fax:
Practice Address - Street 1:26672 PORTOLA PKWY STE 116
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-1773
Practice Address - Country:US
Practice Address - Phone:800-788-5753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist