Provider Demographics
NPI:1518059054
Name:KRISHNAMOORTHI, VIJAYALAKSHMI (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:VIJAYALAKSHMI
Middle Name:
Last Name:KRISHNAMOORTHI
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22890 CRICKET HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014
Mailing Address - Country:US
Mailing Address - Phone:408-873-1275
Mailing Address - Fax:
Practice Address - Street 1:10050 BUBB ROAD
Practice Address - Street 2:SUITE #2
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-4160
Practice Address - Country:US
Practice Address - Phone:408-996-2220
Practice Address - Fax:408-865-0416
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist