Provider Demographics
NPI:1043548530
Name:PATHAK, PARTHIV MOULESHKUMAR (PT)
Entity Type:Individual
Prefix:
First Name:PARTHIV
Middle Name:MOULESHKUMAR
Last Name:PATHAK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 BELLA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-2632
Mailing Address - Country:US
Mailing Address - Phone:732-713-4781
Mailing Address - Fax:
Practice Address - Street 1:2328 BELLA VISTA WAY
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-2632
Practice Address - Country:US
Practice Address - Phone:732-713-4781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032052225100000X
FLPT26280171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400030533Medicare PIN
NYA400028635Medicare PIN
NYA400022823Medicare PIN
NYA400026104Medicare PIN
NYA400030321Medicare PIN