MEDICARE: DEEPIKA KALLURI MEKA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251G0304X	Geriatric Physical Therapist	1230828	TX

General Provider Information

NPI Number	:	1407244544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEPIKA KALLURI MEKA

Provider Business Mailing Address
First Line	:	1517 NEWTON RANCH RD
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-1655
Country	:	US
Telephone Number	:	626-319-6625
Fax Number	:

Provider Business Practice Location Address
First Line	:	1517 NEWTON RANCH RD
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-1655
Country	:	US
Telephone Number	:	626-319-6625
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2014
Last Update Date	:	08/19/2020

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