Healthcare Provider Details

I. General information

NPI: 1255373239
Provider Name (Legal Business Name): PAMELA KONDRA SILLS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 103
JEFFERSONVILLE VT
05464-0103
US

IV. Provider business mailing address

PO BOX 103
JEFFERSONVILLE VT
05464
US

V. Phone/Fax

Practice location:
  • Phone: 802-644-8011
  • Fax: 802-644-8047
Mailing address:
  • Phone: 802-644-8011
  • Fax: 802-644-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0400002460
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: