MEDICARE: KETKI MANOHAR RANA PT

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	225100000X	Physical Therapist	1240097	TX

General Provider Information

NPI Number	:	1144649088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KETKI MANOHAR RANA PT

Provider Business Mailing Address
First Line	:	3629 WESTERN CENTER BLVD
Second Line	:	STE.221
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1939
Country	:	US
Telephone Number	:	817-566-6793
Fax Number	:

Provider Business Practice Location Address
First Line	:	3629 WESTERN CENTER BLVD
Second Line	:	STE.221
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1939
Country	:	US
Telephone Number	:	817-566-6793
Fax Number	:

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

Provider Enumeration Date	:	04/08/2014
Last Update Date	:	04/08/2014

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