Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 012705 | OH |
NPI | 1013281260 |
---|---|
Provider Name | Deepa Makkar Kalliath |
First Address | Cincinnati, OH 45236-2227 |
Second Address | Cincinnati, OH 45236-2227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2012 |
Last Update Date | 12/04/2012 |