Provider Demographics
NPI:1093004798
Name:PRASAD, NANDINI VIVEK (PT)
Entity Type:Individual
Prefix:
First Name:NANDINI
Middle Name:VIVEK
Last Name:PRASAD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-2250
Mailing Address - Country:US
Mailing Address - Phone:856-522-9074
Mailing Address - Fax:
Practice Address - Street 1:300 E WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-2250
Practice Address - Country:US
Practice Address - Phone:856-522-9074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist