Healthcare Provider Details

I. General information

NPI: 1023111465
Provider Name (Legal Business Name): PAMELA JOHNSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 BRIDGEWAY STE 301
SAUSALITO CA
94965-4804
US

IV. Provider business mailing address

4000 BRIDGEWAY STE 301
SAUSALITO CA
94965-4804
US

V. Phone/Fax

Practice location:
  • Phone: 415-497-6587
  • Fax: 415-383-6744
Mailing address:
  • Phone: 415-497-6587
  • Fax: 415-383-6744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT16542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: