Provider Demographics
NPI:1548266760
Name:DESAI, ROOPA M (PT)
Entity type:Individual
Prefix:MRS
First Name:ROOPA
Middle Name:M
Last Name:DESAI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 JANMAR RD
Mailing Address - Street 2:STE B
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5693
Mailing Address - Country:US
Mailing Address - Phone:770-972-8536
Mailing Address - Fax:770-736-9629
Practice Address - Street 1:1561 JANMAR RD
Practice Address - Street 2:STE B
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5693
Practice Address - Country:US
Practice Address - Phone:770-972-8536
Practice Address - Fax:770-736-9629
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00149727OtherRAILROAD MEDICARE PIN
GADC1303OtherRAILROAD MEDICARE GRP ID
GA65BBCKMMedicare UPIN
GAGRP6280Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER