Provider Demographics
NPI:1710547559
Name:GOPINATHA PILLAI, PRASANTHA KUMAR
Entity Type:Individual
Prefix:MR
First Name:PRASANTHA
Middle Name:KUMAR
Last Name:GOPINATHA PILLAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S FARMVIEW DR APT F12
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3376
Mailing Address - Country:US
Mailing Address - Phone:302-242-6501
Mailing Address - Fax:
Practice Address - Street 1:1175 MCKEE RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-2268
Practice Address - Country:US
Practice Address - Phone:302-744-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0004084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist