Provider Demographics
NPI:1609155027
Name:ANANTHAKRISHNAN, DEEPTHI (PT)
Entity Type:Individual
Prefix:
First Name:DEEPTHI
Middle Name:
Last Name:ANANTHAKRISHNAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DEEPTHI
Other - Middle Name:
Other - Last Name:SUBRAMANIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1851 LOMBARD ST
Mailing Address - Street 2:100
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-8231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1851 LOMBARD ST
Practice Address - Street 2:100
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-8231
Practice Address - Country:US
Practice Address - Phone:805-983-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist