MEDICARE: MR. SIVA SANKAR KRISHNAN P.T.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	3345	NC

General Provider Information

NPI Number	:	1033236260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SIVA SANKAR KRISHNAN P.T.A.

Provider Business Mailing Address
First Line	:	903 W MAIN ST
Second Line	:
City	:	YADKINVILLE
State	:	NC
Zip	:	27055-7807
Country	:	US
Telephone Number	:	336-679-8863
Fax Number	:

Provider Business Practice Location Address
First Line	:	903 W MAIN ST
Second Line	:
City	:	YADKINVILLE
State	:	NC
Zip	:	27055-7807
Country	:	US
Telephone Number	:	336-679-8863
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	06/10/2011

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Directions to “ MR. SIVA SANKAR KRISHNAN P.T.A.” Practice Location

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