MEDICARE: PAMELA LOUISE FLETCHER MAINE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0093531	NY
2	225100000X	Physical Therapist	0400089086	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346288834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA LOUISE FLETCHER MAINE PT

Provider Business Mailing Address
First Line	:	5468 MAIN ST
Second Line	:	PO BOX 1224
City	:	MANCHESTER CENTER
State	:	VT
Zip	:	05255-9481
Country	:	US
Telephone Number	:	802-362-2126
Fax Number	:	802-362-4884

Provider Business Practice Location Address
First Line	:	5468 MAIN ST
Second Line	:
City	:	MANCHESTER CENTER
State	:	VT
Zip	:	05255-9481
Country	:	US
Telephone Number	:	802-362-2126
Fax Number	:	802-362-4884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	08/21/2014

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