Provider Demographics
NPI:1457388761
Name:PRABHAKAR, MEENAKSHI (DPT)
Entity type:Individual
Prefix:
First Name:MEENAKSHI
Middle Name:
Last Name:PRABHAKAR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1494 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2929
Mailing Address - Country:US
Mailing Address - Phone:212-810-9003
Mailing Address - Fax:
Practice Address - Street 1:5980 STONERIDGE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4518
Practice Address - Country:US
Practice Address - Phone:925-847-8833
Practice Address - Fax:925-947-8772
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025677225100000X
CA34882225100000X
MA16649225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06873ZMedicare PIN
CAFN499ZMedicare PIN