Provider Demographics
NPI:1184943300
Name:KULKARNI, HETAL S (PT, MS)
Entity type:Individual
Prefix:
First Name:HETAL
Middle Name:S
Last Name:KULKARNI
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 W CRYSTAL ST UNIT D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-8801
Mailing Address - Country:US
Mailing Address - Phone:317-979-5242
Mailing Address - Fax:
Practice Address - Street 1:1733 W CRYSTAL ST UNIT D
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-8801
Practice Address - Country:US
Practice Address - Phone:317-979-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015197225100000X
IL070019149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070019149OtherPHYSICAL THERAPY LICENSE
MI5501015197OtherPHYSICAL THERAPY LICENSE