MEDICARE: MR. KUNNARA KET PTA

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	225200000X	Physical Therapy Assistant	A 0424	NV
2	225200000X	Physical Therapy Assistant	8518	OR

General Provider Information

NPI Number	:	1134389455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KUNNARA KET PTA

Provider Business Mailing Address
First Line	:	238 W CLEVELAND AVE
Second Line	:	APT D
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-5023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6151 VEGAS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2514
Country	:	US
Telephone Number	:	702-853-2640
Fax Number	:

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

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	06/10/2008

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Directions to “ MR. KUNNARA KET PTA” Practice Location

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