MEDICARE: PAMELA GILLS

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	225200000X	Physical Therapy Assistant	001142	WV

General Provider Information

NPI Number	:	1417648841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA GILLS

Provider Business Mailing Address
First Line	:	545 AIRPORT RD STE 101
Second Line	:
City	:	BLUEFIELD
State	:	WV
Zip	:	24701-7388
Country	:	US
Telephone Number	:	304-325-0066
Fax Number	:	304-325-0077

Provider Business Practice Location Address
First Line	:	545 AIRPORT RD
Second Line	:
City	:	BLUEFIELD
State	:	WV
Zip	:	24701-7388
Country	:	US
Telephone Number	:	304-325-0066
Fax Number	:	304-325-0077

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

Provider Enumeration Date	:	05/17/2023
Last Update Date	:	05/17/2023

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1992448054 — KAYDEE M MOORE RN
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Directions to “ PAMELA GILLS ” Practice Location

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