Provider Demographics
NPI:1427806660
Name:BALLAL, KANIKA ANIRUDDHA (PT, MS)
Entity type:Individual
Prefix:
First Name:KANIKA
Middle Name:ANIRUDDHA
Last Name:BALLAL
Suffix:
Gender:F
Credentials:PT, MS
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Mailing Address - Street 1:15218 UNION TPKE APT 7P
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3924
Mailing Address - Country:US
Mailing Address - Phone:516-988-5110
Mailing Address - Fax:
Practice Address - Street 1:825 7TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6014
Practice Address - Country:US
Practice Address - Phone:212-787-8315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY048714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist