Individual
ANNIE JOYLET BENTLY PRABHAHAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.P.T
Contact information
Practice address
23B PINE CV, MOUNT LAUREL, NJ 08054-2824
(856) 673-1863
Mailing address
23B PINE CV, MOUNT LAUREL, NJ 08054-2824
(856) 673-1863
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT023949
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XOF829401861
BLUECROSS BLUESHIELD
IL
Enumeration date
10/22/2014
Last updated
10/22/2014
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