Provider Demographics
NPI:1295063394
Name:PRABAKARAN, AVRIL (RPT)
Entity type:Individual
Prefix:MS
First Name:AVRIL
Middle Name:
Last Name:PRABAKARAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 CONNECTICUT AVE
Mailing Address - Street 2:APT. D3
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1108
Mailing Address - Country:US
Mailing Address - Phone:417-659-9656
Mailing Address - Fax:417-782-7038
Practice Address - Street 1:214 W. 5TH ST.
Practice Address - Street 2:GMM PRO-CARE PROVIDERS, INC.
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-0000
Practice Address - Country:US
Practice Address - Phone:417-782-2917
Practice Address - Fax:417-782-7038
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist