Provider Demographics
NPI:1447828843
Name:PRASAD, SMRUTI (PT)
Entity type:Individual
Prefix:MRS
First Name:SMRUTI
Middle Name:
Last Name:PRASAD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:PRIYADARSINEE
Other - Middle Name:
Other - Last Name:SMRUTIPRAVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8200 WEST AMARILLO BLVD. APT 515
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124
Mailing Address - Country:US
Mailing Address - Phone:806-567-7877
Mailing Address - Fax:
Practice Address - Street 1:CENTRAL VALLEY ORTHOPEDICS & REHABILITATION
Practice Address - Street 2:244 BROADWAY
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:845-784-4131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist