Provider Demographics
NPI:1144453531
Name:TRIVEDI, PRANAV NAVINCHANDRA (PT)
Entity type:Individual
Prefix:
First Name:PRANAV
Middle Name:NAVINCHANDRA
Last Name:TRIVEDI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 N LAKE HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-3162
Mailing Address - Country:US
Mailing Address - Phone:863-293-4456
Mailing Address - Fax:
Practice Address - Street 1:650 N LAKE HOWARD DR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-3162
Practice Address - Country:US
Practice Address - Phone:863-293-4456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLPT25851225100000X
NY031581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400030455Medicare PIN
NYA400030584Medicare PIN
NYA400018328Medicare PIN
NYA400030443Medicare PIN