Provider Demographics
NPI:1295901346
Name:KRISHNAMOORTHY, PREETHA (PT)
Entity type:Individual
Prefix:
First Name:PREETHA
Middle Name:
Last Name:KRISHNAMOORTHY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 TOWN WALK DR
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3735
Mailing Address - Country:US
Mailing Address - Phone:616-304-7398
Mailing Address - Fax:
Practice Address - Street 1:210 CHATFIELD ST
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1150
Practice Address - Country:US
Practice Address - Phone:203-735-7402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008312174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist