Provider Demographics
NPI:1972335073
Name:GUMASTE, KRISHNA ASHISH
Entity type:Individual
Prefix:MRS
First Name:KRISHNA
Middle Name:ASHISH
Last Name:GUMASTE
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 1:177 N REINO RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3710
Mailing Address - Country:US
Mailing Address - Phone:805-586-0290
Mailing Address - Fax:
Practice Address - Street 1:177 N REINO RD
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3710
Practice Address - Country:US
Practice Address - Phone:805-586-0290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT306334225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist