Provider Demographics
NPI:1902853476
Name:PILAKEL, PRADEEP DIWAKER (PT,MS,MCSP,DIPTP)
Entity Type:Individual
Prefix:MR
First Name:PRADEEP
Middle Name:DIWAKER
Last Name:PILAKEL
Suffix:
Gender:M
Credentials:PT,MS,MCSP,DIPTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 EAST ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-4132
Mailing Address - Country:US
Mailing Address - Phone:704-982-3656
Mailing Address - Fax:704-982-3657
Practice Address - Street 1:1003 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-2801
Practice Address - Country:US
Practice Address - Phone:704-982-3656
Practice Address - Fax:704-982-3657
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP4468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210810Medicaid
NC650022338OtherRAILROAD MEDICARE PROV. #
NC1115XOtherBCBS PROV. #
NCP24849Medicare UPIN
NC2503921Medicare ID - Type UnspecifiedPROVIDER #