Provider Demographics
NPI:1053885822
Name:DESITA CARE
Entity type:Organization
Organization Name:DESITA CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SETNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-294-2316
Mailing Address - Street 1:333 GRAND AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2584
Mailing Address - Country:US
Mailing Address - Phone:651-294-2316
Mailing Address - Fax:651-460-9193
Practice Address - Street 1:333 GRAND AVE STE 103
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2584
Practice Address - Country:US
Practice Address - Phone:651-294-2316
Practice Address - Fax:651-460-9193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty