Healthcare Provider Details

I. General information

NPI: 1316490782
Provider Name (Legal Business Name): PAMELA SAXON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA KREUTHMEIER PT

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 OHIO ST
RACINE WI
53405-3157
US

IV. Provider business mailing address

815 BLAINE AVE
RACINE WI
53405-2407
US

V. Phone/Fax

Practice location:
  • Phone: 262-995-7291
  • Fax: 262-995-7292
Mailing address:
  • Phone: 262-632-3035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2522
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: