Provider Demographics
NPI:1124581715
Name:DHOTRE, PRARTHANA (DR)
Entity type:Individual
Prefix:
First Name:PRARTHANA
Middle Name:
Last Name:DHOTRE
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 EVERIT AVE
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8137
Mailing Address - Country:US
Mailing Address - Phone:909-674-4468
Mailing Address - Fax:
Practice Address - Street 1:620 N WILCOX AVE APT C
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3171
Practice Address - Country:US
Practice Address - Phone:909-674-4468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALL4568436OtherCVS STUDENT HEALTH PLAN