Healthcare Provider Details

I. General information

NPI: 1710547559
Provider Name (Legal Business Name): MR. PRASANTHA KUMAR GOPINATHA PILLAI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 MCKEE RD
DOVER DE
19904-2268
US

IV. Provider business mailing address

1300 S FARMVIEW DR APT F12
DOVER DE
19904-3376
US

V. Phone/Fax

Practice location:
  • Phone: 302-744-3600
  • Fax:
Mailing address:
  • Phone: 302-242-6501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0004084
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: