Healthcare Provider Details

I. General information

NPI: 1396660163
Provider Name (Legal Business Name): PAMELA L WHITESIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 MOODY RD APT 109
N FT MYERS FL
33903-4702
US

IV. Provider business mailing address

950 MOODY RD APT 109
N FT MYERS FL
33903-4702
US

V. Phone/Fax

Practice location:
  • Phone: 239-322-8133
  • Fax:
Mailing address:
  • Phone: 239-322-8133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA26246
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: