Provider Demographics
NPI:1235478298
Name:KRISHNAN, ANITA PADMANABHAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:PADMANABHAN
Last Name:KRISHNAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26741 PORTOLA PKWY STE 1E-630
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-1743
Mailing Address - Country:US
Mailing Address - Phone:949-597-2103
Mailing Address - Fax:949-597-2061
Practice Address - Street 1:5 JOURNEY STE 100
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656
Practice Address - Country:US
Practice Address - Phone:949-716-4548
Practice Address - Fax:949-271-2311
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294621225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist