Provider Demographics
NPI:1902870652
Name:KRIKORIAN, MARTHA MELISSA (MPT)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:MELISSA
Last Name:KRIKORIAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2890 GREAT SMOKEY CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3728
Mailing Address - Country:US
Mailing Address - Phone:805-495-5187
Mailing Address - Fax:805-495-1305
Practice Address - Street 1:2890 GREAT SMOKEY CT
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3728
Practice Address - Country:US
Practice Address - Phone:805-495-5187
Practice Address - Fax:805-495-1305
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist