Basic Information
Provider Information | |||||||||
NPI: | 1326149584 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PARSOTAM | ||||||||
FirstName: | PRITI | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2775 SCHOENERSVILLE RD | ||||||||
Address2: |   | ||||||||
City: | BETHLEHEM | ||||||||
State: | PA | ||||||||
PostalCode: | 180177307 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6108618080 | ||||||||
FaxNumber: | 6108618080 | ||||||||
Practice Location | |||||||||
Address1: | 2414 MEADOW RIDGE DR | ||||||||
Address2: |   | ||||||||
City: | CHINO HILLS | ||||||||
State: | CA | ||||||||
PostalCode: | 917091747 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9092176866 | ||||||||
FaxNumber: | 9096321280 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/26/2006 | ||||||||
LastUpdateDate: | 11/29/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT011377L | PA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 855007 | 01 |   | HEALTH AMERICA/HEALTH ASSURANCE | OTHER | 2023286 | 01 |   | HIGHMARK BLUE SHIELD | OTHER | 47241 | 01 |   | GEISINGER HEALTH PLAN | OTHER | 7709482 | 01 |   | AETNA PPO | OTHER | 50076788 | 01 |   | CAPITAL BLUE CROSS | OTHER | 1863358 | 01 |   | AETNA HMO | OTHER | 50076788 | 01 |   | KEYSTONE HEALTH PLAN CENTRAL | OTHER |