Healthcare Provider Details

I. General information

NPI: 1508341108
Provider Name (Legal Business Name): PAMELA CARTER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 17TH ST
MODESTO CA
95354-1209
US

IV. Provider business mailing address

730 17TH ST
MODESTO CA
95354-1209
US

V. Phone/Fax

Practice location:
  • Phone: 209-248-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number295629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: