Provider Demographics
NPI:1932680329
Name:KABANI, GULZAR VIRANI
Entity Type:Individual
Prefix:
First Name:GULZAR
Middle Name:VIRANI
Last Name:KABANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E VISTA RIDGE MALL DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8339
Mailing Address - Country:US
Mailing Address - Phone:972-906-9789
Mailing Address - Fax:
Practice Address - Street 1:700 E VISTA RIDGE MALL DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8339
Practice Address - Country:US
Practice Address - Phone:972-906-9789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209014224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant