Provider Demographics
NPI:1659656452
Name:KHALSA, DEVAKAUR HARPREET (LMT, DOM)
Entity Type:Individual
Prefix:
First Name:DEVAKAUR
Middle Name:HARPREET
Last Name:KHALSA
Suffix:
Gender:F
Credentials:LMT, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 COUNTRY RD 122
Mailing Address - Street 2:
Mailing Address - City:ESAPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532
Mailing Address - Country:US
Mailing Address - Phone:505-753-7576
Mailing Address - Fax:505-753-7676
Practice Address - Street 1:82 COUNTRY RD 122
Practice Address - Street 2:
Practice Address - City:ESAPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532
Practice Address - Country:US
Practice Address - Phone:505-753-7576
Practice Address - Fax:505-753-7676
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist