Provider Demographics
NPI:1336858141
Name:PALLATTU VASUDEVA PANICKER, DILEEP KUMAR (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:DILEEP
Middle Name:KUMAR
Last Name:PALLATTU VASUDEVA PANICKER
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 12B 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-1879
Mailing Address - Country:US
Mailing Address - Phone:845-453-4439
Mailing Address - Fax:
Practice Address - Street 1:247 12B 76TH AVE
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-1879
Practice Address - Country:US
Practice Address - Phone:845-453-4439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty