Provider Demographics
NPI:1669954715
Name:AMARESAN, KAVITHA SALOMI (MSPT)
Entity type:Individual
Prefix:
First Name:KAVITHA
Middle Name:SALOMI
Last Name:AMARESAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26335 CEDAR PINE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5781
Mailing Address - Country:US
Mailing Address - Phone:930-818-2767
Mailing Address - Fax:
Practice Address - Street 1:401 N ELM ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4137
Practice Address - Country:US
Practice Address - Phone:940-387-4496
Practice Address - Fax:940-380-2429
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1189880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist