Individual provider Active NPI

John V Desiato, PT

  • Physical Therapist
  • Littleton, CO
National Provider Identifier
1851316160
Registry record updated Jun 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PTL0005430 Issued in CO
Practice address
6169 S Balsam Way Ste 110
Littleton, CO 80123
Phone
(339) 481-1868
Fax
(303) 948-1741
NPI assigned
Jul 13, 2006
Last updated
Jun 13, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PTL0005430 CO Primary

Addresses

Primary practice location

6169 S Balsam Way Ste 110
Littleton, CO 80123

Mailing address

6169 S Balsam Way Ste 110
Littleton, CO 80123-3000
Phone (303) 948-1868

Other identifiers 1

IdentifierTypeStateIssuer
52780066MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PTL0005430COMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Functional Performance Physical Therapy Center, PLLC Physical Therapist Current Accepting new patients
Functional Performance Physical Therapy Center Current Accepting new patients
Western Physical Therapy Specialists, LLC Physical Therapist CurrentSince Aug 1, 2020 Accepting new patients

Locations

15000 W 6th Ave
Ste 106
Golden, CO 80401
Phone (720) 541-6817

6169 S Balsam Way
Ste 110
Littleton, CO 80123
Phone (303) 948-1868

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1851316160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6169 S BALSAM WAY STE 110",
            "city": "LITTLETON",
            "state": "CO",
            "postal_code": "801233000",
            "telephone_number": "303-948-1868",
            "fax_number": "303-948-1741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6169 S BALSAM WAY STE 110",
            "city": "LITTLETON",
            "state": "CO",
            "postal_code": "80123",
            "telephone_number": "339-481-1868",
            "fax_number": "303-948-1741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESIATO",
        "first_name": "JOHN",
        "middle_name": "V",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2023-06-13",
        "certification_date": "2022-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL0005430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "52780066",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Littleton, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.