Provider Demographics
NPI:1851720460
Name:DATT, PRAGYA (PT)
Entity Type:Individual
Prefix:
First Name:PRAGYA
Middle Name:
Last Name:DATT
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 1:1019 WICKER ST
Mailing Address - Street 2:MOSES LUDINGTON HOSPITAL
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-1039
Mailing Address - Country:US
Mailing Address - Phone:518-585-3810
Mailing Address - Fax:518-585-3822
Practice Address - Street 1:1019 WICKER STREET
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883
Practice Address - Country:US
Practice Address - Phone:518-585-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY034811OtherLICENSE