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General NPI Number Information
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NPI Number | 1437955762
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Entity Type | Organization
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Legal Business Name | PAM PHYSICIAN ENTERPRISE
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 6500 W 104TH AVE
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City | WESTMINSTER
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State | CO
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Zip | 80020-4189
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Country | US
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Telephone | 720-653-3440
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 206478
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City | DALLAS
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State | TX
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Zip | 75320-6478
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTHONY MISITANO
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Credential |
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Telephone | 717-731-9660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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