Provider Demographics
NPI:1003327586
Name:PRASEETHA ULLAL KOLAP, FNU (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:PRASEETHA ULLAL KOLAP
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:PRASEETHA
Other - Middle Name:ULLAL
Other - Last Name:KOLAPURATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:5211 FREDERICKSBURG RD APT 1319
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4104
Mailing Address - Country:US
Mailing Address - Phone:708-571-9504
Mailing Address - Fax:
Practice Address - Street 1:5211 FREDERICKSBURG RD APT 1319
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4104
Practice Address - Country:US
Practice Address - Phone:708-571-9504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042121225100000X
TX1297879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist