Provider Demographics
NPI:1912016510
Name:JAYAPRAKASH, PRASHANTH (MPT)
Entity Type:Individual
Prefix:MR
First Name:PRASHANTH
Middle Name:
Last Name:JAYAPRAKASH
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 SAINT MICHAELS CT
Mailing Address - Street 2:STE 203
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2615
Mailing Address - Country:US
Mailing Address - Phone:443-838-8681
Mailing Address - Fax:
Practice Address - Street 1:132 HOLIDAY CT
Practice Address - Street 2:STE 203
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7005
Practice Address - Country:US
Practice Address - Phone:410-573-9930
Practice Address - Fax:410-573-9932
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21392OtherLICENSE #