Healthcare Provider Details

I. General information

NPI: 1366976276
Provider Name (Legal Business Name): PAM SQUARED AT LAS VEGAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6166 NORTH DURANGO DRIVE
LAS VEGAS NV
89149
US

IV. Provider business mailing address

1828 GOOD HOPE RD SUITE 101
ENOLA PA
17025-1203
US

V. Phone/Fax

Practice location:
  • Phone: 725-223-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

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