Provider Demographics
NPI:1831756709
Name:SCHULTE, KOMAL
Entity type:Individual
Prefix:
First Name:KOMAL
Middle Name:
Last Name:SCHULTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KOMAL
Other - Middle Name:SANTOSH
Other - Last Name:PANDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6774 102ND AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782
Mailing Address - Country:US
Mailing Address - Phone:727-289-0062
Mailing Address - Fax:
Practice Address - Street 1:6774 102ND AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782
Practice Address - Country:US
Practice Address - Phone:727-289-0062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist