MEDICARE: KRISHNA RITA

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	225100000X	Physical Therapist
2	225100000X	Physical Therapist	PT34815	FL

General Provider Information

NPI Number	:	1417431842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISHNA RITA

Provider Business Mailing Address
First Line	:	1462 HARVARD CIR APT 204
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-2229
Country	:	US
Telephone Number	:	925-725-5623
Fax Number	:

Provider Business Practice Location Address
First Line	:	156 NW CALIFORNIA BLVD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-2492
Country	:	US
Telephone Number	:	772-871-7170
Fax Number	:

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

Provider Enumeration Date	:	09/21/2018
Last Update Date	:	08/02/2020

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Directions to “ KRISHNA RITA ” Practice Location

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