Provider Demographics
NPI:1134389455
Name:KET, KUNNARA (PTA)
Entity type:Individual
Prefix:MR
First Name:KUNNARA
Middle Name:
Last Name:KET
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:NARA
Other - Middle Name:
Other - Last Name:KET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:238 W CLEVELAND AVE
Mailing Address - Street 2:APT D
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-5023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6151 VEGAS DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-2514
Practice Address - Country:US
Practice Address - Phone:702-853-2640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA 0424225200000X
OR8518225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant