Provider Demographics
NPI:1164537973
Name:MOORTHY, PRATHIMA (MD)
Entity Type:Individual
Prefix:
First Name:PRATHIMA
Middle Name:
Last Name:MOORTHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4760 TAMIAMI TRAIL N
Mailing Address - Street 2:SUITE 27
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103
Mailing Address - Country:US
Mailing Address - Phone:239-593-9594
Mailing Address - Fax:239-593-4099
Practice Address - Street 1:4760 TAMIAMI TRAIL NORTH
Practice Address - Street 2:SUITE 27
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-3884
Practice Address - Country:US
Practice Address - Phone:239-593-9594
Practice Address - Fax:239-593-4099
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0567442081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME056744OtherMEDICAL LICENSE