Provider Demographics
NPI:1548380074
Name:CHALASANI, KRISHNA KANTH (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:KANTH
Last Name:CHALASANI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3867 WILDER RD
Mailing Address - Street 2:HORIZON PHYSICAL THERAPY & REHABILITATION
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2365
Mailing Address - Country:US
Mailing Address - Phone:989-460-0020
Mailing Address - Fax:989-460-0021
Practice Address - Street 1:4121 SHRESTHA DR
Practice Address - Street 2:HORIZON PHYSICAL THERAPY & REHABILITATION
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2171
Practice Address - Country:US
Practice Address - Phone:989-460-0020
Practice Address - Fax:989-460-0021
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501011809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501011809OtherMI STATE LICENSE