Provider Demographics
NPI:1063763506
Name:KORKONDA, KAMAL KISHORE (PT)
Entity type:Individual
Prefix:MR
First Name:KAMAL
Middle Name:KISHORE
Last Name:KORKONDA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18747 MUESCHKE RD STE D
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-8759
Mailing Address - Country:US
Mailing Address - Phone:281-547-8563
Mailing Address - Fax:281-407-7536
Practice Address - Street 1:18747 MUESCHKE RD STE D
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-8759
Practice Address - Country:US
Practice Address - Phone:281-547-8563
Practice Address - Fax:281-407-7536
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11683225100000X
TX1353382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11683OtherPHYSICAL THERAPY LICENSE