Provider Demographics
NPI:1235797440
Name:VITHOONTIEN, PRIMA (DPT)
Entity Type:Individual
Prefix:
First Name:PRIMA
Middle Name:
Last Name:VITHOONTIEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3331
Mailing Address - Country:US
Mailing Address - Phone:212-595-4500
Mailing Address - Fax:212-595-4578
Practice Address - Street 1:246 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3331
Practice Address - Country:US
Practice Address - Phone:212-595-4500
Practice Address - Fax:212-595-4578
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist