Provider Demographics
NPI:1346566718
Name:KRISHNA, MUTHU (LMP, MMLT)
Entity Type:Individual
Prefix:
First Name:MUTHU
Middle Name:
Last Name:KRISHNA
Suffix:
Gender:M
Credentials:LMP, MMLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12402 ADMIRALTY WAY APT C206
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-8570
Mailing Address - Country:US
Mailing Address - Phone:425-210-4525
Mailing Address - Fax:
Practice Address - Street 1:3609 W MUKILTEO BLVD
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-1249
Practice Address - Country:US
Practice Address - Phone:425-210-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-10
Last Update Date:2010-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60133713225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist