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General NPI Number Information
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NPI Number | 1770793317
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Entity Type | Individual
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Provider Name | MINITA C PRABHAKAR DPT, MTC, CLT
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 2505 METROCENTRE BLVD SUITE 201
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-3114
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Country | US
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Telephone | 561-688-1844
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Fax |
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Provider Business Mailing Address
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Address Line | 8161 BAUTISTA WAY
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-8182
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Country | US
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Telephone | 561-222-3034
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 20470
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License Number State | FL
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