Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1230828 | TX |
NPI | 1407244544 |
---|---|
Provider Name | Deepika Kalluri Meka |
First Address | Keller, TX 76248-1655 |
Second Address | Keller, TX 76248-1655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2014 |
Last Update Date | 19/08/2020 |