Healthcare Provider Details

I. General information

NPI: 1578061735
Provider Name (Legal Business Name): PAM PHYSICAL THERAPY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1078 S STATE ST
DOVER DE
19901-6925
US

IV. Provider business mailing address

1828 GOOD HOPE RD STE 102
ENOLA PA
17025-1203
US

V. Phone/Fax

Practice location:
  • Phone: 717-731-9660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY MISITANO
Title or Position: PRESIDENT
Credential:
Phone: 717-731-9660