Provider Demographics
NPI:1093353468
Name:THAKKAR, KAPIL
Entity Type:Individual
Prefix:
First Name:KAPIL
Middle Name:
Last Name:THAKKAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10851 CRESCENT MOON DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-4020
Mailing Address - Country:US
Mailing Address - Phone:214-620-1010
Mailing Address - Fax:
Practice Address - Street 1:10851 CRESCENT MOON DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-4020
Practice Address - Country:US
Practice Address - Phone:214-620-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1277341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist