Provider Demographics
NPI:1134416696
Name:DEOLE, DARSHAN A (DPT)
Entity type:Individual
Prefix:
First Name:DARSHAN
Middle Name:A
Last Name:DEOLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:816-226-4011
Mailing Address - Fax:816-524-6115
Practice Address - Street 1:10801 E STATE ROUTE 350
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-2367
Practice Address - Country:US
Practice Address - Phone:816-737-5500
Practice Address - Fax:816-737-5504
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011021971225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
45791024OtherBCBS KC
MOMA4370055OtherMEDICARE PTAN
MO45791014OtherBCBS OF KC