Basic Information
| Provider Information | |||||||||
| NPI: | 1841836210 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALAKRISHNAN | ||||||||
| FirstName: | ANUJA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13388 DISTRICT PKWY UNIT 205 | ||||||||
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| City: | FISHERS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460377750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174107170 | ||||||||
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| Practice Location | |||||||||
| Address1: | 511 SW 10TH AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972052700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032947463 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2019 | ||||||||
| LastUpdateDate: | 11/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 05011033A | IN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 63460 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.