Provider Demographics
NPI:1689045072
Name:NIRMAL, KINJAL (MPT)
Entity Type:Individual
Prefix:
First Name:KINJAL
Middle Name:
Last Name:NIRMAL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KINJAL
Other - Middle Name:
Other - Last Name:NIRMAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39440 CIVIC CENTER DR
Mailing Address - Street 2:APT 509
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-3285
Mailing Address - Country:US
Mailing Address - Phone:201-932-3831
Mailing Address - Fax:
Practice Address - Street 1:2805 WHIPPLE RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1233
Practice Address - Country:US
Practice Address - Phone:510-441-8906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20088225100000X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist