Provider Demographics
NPI:1699076141
Name:KRISHNAN, ADITI
Entity type:Individual
Prefix:
First Name:ADITI
Middle Name:
Last Name:KRISHNAN
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 1:24885 RAVINE SQ
Mailing Address - Street 2:APT # 106
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2479
Mailing Address - Country:US
Mailing Address - Phone:317-418-3019
Mailing Address - Fax:
Practice Address - Street 1:24885 RAVINE SQ
Practice Address - Street 2:APT # 106
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-2479
Practice Address - Country:US
Practice Address - Phone:317-418-3019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist