Provider Demographics
NPI:1205339892
Name:KRISHNA, DEEPA (PT)
Entity type:Individual
Prefix:MRS
First Name:DEEPA
Middle Name:
Last Name:KRISHNA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:DEEPA
Other - Middle Name:
Other - Last Name:KRISHNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:12501 BROADWAY, #21106
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7422
Mailing Address - Country:US
Mailing Address - Phone:832-508-2894
Mailing Address - Fax:
Practice Address - Street 1:12501 BROADWAY, #21106
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7422
Practice Address - Country:US
Practice Address - Phone:832-508-2894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1206437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty