Provider Demographics
NPI:1528494804
Name:THOTTICHIRA, ABRAHAM (DPT)
Entity type:Individual
Prefix:MR
First Name:ABRAHAM
Middle Name:
Last Name:THOTTICHIRA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 DEL PRADO BLVD S
Mailing Address - Street 2:D203
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-6105
Mailing Address - Country:US
Mailing Address - Phone:574-276-3185
Mailing Address - Fax:
Practice Address - Street 1:10201 ARCOS AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-9459
Practice Address - Country:US
Practice Address - Phone:239-425-6909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.013106225100000X
FLPT28854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHQ383ZMedicare PIN