Healthcare Provider Details

I. General information

NPI: 1285843243
Provider Name (Legal Business Name): PAMELA THOMPSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N JEFFERSON ST
MONTICELLO FL
32344-2060
US

IV. Provider business mailing address

920 CAIRO RD
THOMASVILLE GA
31792-4255
US

V. Phone/Fax

Practice location:
  • Phone: 850-997-8522
  • Fax: 850-997-3022
Mailing address:
  • Phone: 229-227-5500
  • Fax: 229-227-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA1343
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: