Provider Demographics
NPI:1679574784
Name:MODY, KAMAL (PT)
Entity type:Individual
Prefix:MR
First Name:KAMAL
Middle Name:
Last Name:MODY
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 1:7651 SW HIGHWAY 200 STE 206
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-7727
Mailing Address - Country:US
Mailing Address - Phone:352-237-7646
Mailing Address - Fax:352-237-7728
Practice Address - Street 1:2135 SW 19TH AVENUE RD STE 103
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7877
Practice Address - Country:US
Practice Address - Phone:352-368-1340
Practice Address - Fax:352-237-7728
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY086JZMedicare ID - Type Unspecified