Provider Demographics
NPI:1801814264
Name:KRISHNAN, AJAYAGHOSH M (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:
First Name:AJAYAGHOSH
Middle Name:M
Last Name:KRISHNAN
Suffix:
Gender:M
Credentials:PHYSICAL THERAPY
Other - Prefix:
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Mailing Address - Street 1:14850 STONEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-9500
Mailing Address - Country:US
Mailing Address - Phone:419-344-1425
Mailing Address - Fax:419-578-7361
Practice Address - Street 1:1245 SCHREIER RD
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1443
Practice Address - Country:US
Practice Address - Phone:419-578-7360
Practice Address - Fax:419-578-7361
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT001582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist