Provider Demographics
NPI:1487304044
Name:PATHAK, DIPTEE (PT, DPT)
Entity type:Individual
Prefix:
First Name:DIPTEE
Middle Name:
Last Name:PATHAK
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 1:470 S CALLE ENCILIA UNIT B16
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7585
Mailing Address - Country:US
Mailing Address - Phone:302-668-3639
Mailing Address - Fax:
Practice Address - Street 1:41505 CARLOTTA DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-3279
Practice Address - Country:US
Practice Address - Phone:760-600-5904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-26
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300574225100000X
DEJ100149122251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist