Provider Demographics
NPI:1780815050
Name:PRABHU, PRITI VINAYAK (MSPT)
Entity Type:Individual
Prefix:
First Name:PRITI
Middle Name:VINAYAK
Last Name:PRABHU
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9108 DRUMALDRY DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-3341
Mailing Address - Country:US
Mailing Address - Phone:301-986-0367
Mailing Address - Fax:
Practice Address - Street 1:5215 W CEDAR LN
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1548
Practice Address - Country:US
Practice Address - Phone:301-897-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist