Provider Demographics
NPI:1861518508
Name:KASHYAP, KAMAL KISHORE (RPT)
Entity type:Individual
Prefix:
First Name:KAMAL
Middle Name:KISHORE
Last Name:KASHYAP
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 PRATT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-8901
Mailing Address - Country:US
Mailing Address - Phone:989-488-4569
Mailing Address - Fax:
Practice Address - Street 1:3200 PRATT LAKE RD
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-8901
Practice Address - Country:US
Practice Address - Phone:989-488-4569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist