Provider Demographics
NPI:1134474877
Name:DEOKULE, KOMAL (PT,MSCPT,CCS)
Entity type:Individual
Prefix:
First Name:KOMAL
Middle Name:
Last Name:DEOKULE
Suffix:
Gender:F
Credentials:PT,MSCPT,CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 910883
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92191-0883
Mailing Address - Country:US
Mailing Address - Phone:858-336-9338
Mailing Address - Fax:
Practice Address - Street 1:5353 MISSION CENTER RD
Practice Address - Street 2:STE 120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1306
Practice Address - Country:US
Practice Address - Phone:858-255-7976
Practice Address - Fax:858-255-7969
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 35986225100000X
2251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary