Provider Demographics
NPI:1548741101
Name:KRISHNA, TASHEENA TANEE
Entity Type:Individual
Prefix:
First Name:TASHEENA
Middle Name:TANEE
Last Name:KRISHNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 WESTBERRY CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-5506
Mailing Address - Country:US
Mailing Address - Phone:317-625-3276
Mailing Address - Fax:
Practice Address - Street 1:4904 WAR ADMIRAL DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-9737
Practice Address - Country:US
Practice Address - Phone:317-884-5741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010881A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05010881AOtherIN PLA