Provider Demographics
NPI:1033601273
Name:KOUL-KUMAR, PAYAL (PT)
Entity Type:Individual
Prefix:MRS
First Name:PAYAL
Middle Name:
Last Name:KOUL-KUMAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15697 CEDAR COVE DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-7870
Mailing Address - Country:US
Mailing Address - Phone:574-343-6954
Mailing Address - Fax:
Practice Address - Street 1:12655 STATE ROAD 23
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9641
Practice Address - Country:US
Practice Address - Phone:574-343-6427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010642A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty