Provider Demographics
NPI:1366634214
Name:GAZULA, KISHORE NK (MHS PT)
Entity Type:Individual
Prefix:
First Name:KISHORE
Middle Name:NK
Last Name:GAZULA
Suffix:
Gender:M
Credentials:MHS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2703 FOX HARBOUR DEN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-3811
Mailing Address - Country:US
Mailing Address - Phone:317-457-6656
Mailing Address - Fax:
Practice Address - Street 1:1109 S INDIANA ST
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-1926
Practice Address - Country:US
Practice Address - Phone:176-565-3143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008899A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist