Provider Demographics
NPI:1144648585
Name:DIGWAL, DEVESH
Entity type:Individual
Prefix:
First Name:DEVESH
Middle Name:
Last Name:DIGWAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2083 E 14 ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3313
Mailing Address - Country:US
Mailing Address - Phone:806-786-9757
Mailing Address - Fax:
Practice Address - Street 1:143 JOHN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3337
Practice Address - Country:US
Practice Address - Phone:831-422-4782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037002225100000X
CAPT294269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist