Healthcare Provider Details

I. General information

NPI: 1629021746
Provider Name (Legal Business Name): BHAKTI PRABHU PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 GREENWICH AVE C/O EQUINOX 3RD FLOOR
NEW YORK NY
10014-5203
US

IV. Provider business mailing address

97 GREENWICH AVE C/O EQUINOX 3RD FLOOR
NEW YORK NY
10014-5203
US

V. Phone/Fax

Practice location:
  • Phone: 212-741-9288
  • Fax: 212-741-6826
Mailing address:
  • Phone: 212-741-9288
  • Fax: 212-741-6826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number27242
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: