Provider Demographics
NPI:1851762850
Name:KASULA, MAHALAXMI (PT,DPT)
Entity Type:Individual
Prefix:
First Name:MAHALAXMI
Middle Name:
Last Name:KASULA
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8459 TWISTPINE RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-1152
Mailing Address - Country:US
Mailing Address - Phone:732-703-4466
Mailing Address - Fax:
Practice Address - Street 1:1932 WALNUT PLZ
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-5810
Practice Address - Country:US
Practice Address - Phone:469-892-5222
Practice Address - Fax:972-810-0115
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA419782251P0200X
TX1236180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX427146201Medicaid