Provider Demographics
NPI:1194120121
Name:BISWAS, DEEPA GOELA (MSPT)
Entity type:Individual
Prefix:
First Name:DEEPA
Middle Name:GOELA
Last Name:BISWAS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 CHAMPION GRANDVIEW WAY
Mailing Address - Street 2:APT 8112
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-8223
Mailing Address - Country:US
Mailing Address - Phone:201-618-2119
Mailing Address - Fax:
Practice Address - Street 1:6500 CHAMPION GRANDVIEW WAY
Practice Address - Street 2:APT 8112
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-8223
Practice Address - Country:US
Practice Address - Phone:201-618-2119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12453152251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics