Healthcare Provider Details

I. General information

NPI: 1447405055
Provider Name (Legal Business Name): PAMELA ABBOTT PT, DPT, OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 LACLEDE AVE MARCHETTI TOWERS WEST
SAINT LOUIS MO
63103-2011
US

IV. Provider business mailing address

3530 LACLEDE AVE MARCHETTI TOWERS WEST
SAINT LOUIS MO
63103-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-7419
  • Fax: 314-977-2070
Mailing address:
  • Phone: 314-977-7419
  • Fax: 314-977-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2005004580
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: