Individual
PRATYUSHA NISTALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
227 W 29TH ST RM 3R, NEW YORK, NY 10001-5574
(212) 736-8900
(212) 736-8158
Mailing address
227 W 29TH ST RM 3R, NEW YORK, NY 10001-5574
(212) 736-8900
(212) 736-8158
Taxonomy
Speciality
Code
Description
License number
State
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
040300-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z2459030
PASSPORT
—
Enumeration date
02/23/2018
Last updated
06/16/2018
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