Provider Demographics
NPI:1013498674
Name:DEO, KETAKI (PT)
Entity Type:Individual
Prefix:MISS
First Name:KETAKI
Middle Name:
Last Name:DEO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11004 CORALBERRY DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-3109
Mailing Address - Country:US
Mailing Address - Phone:619-200-3109
Mailing Address - Fax:
Practice Address - Street 1:3511 CORINTH PKWY
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76208-5384
Practice Address - Country:US
Practice Address - Phone:619-200-3109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1246290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist