MEDICARE: PAMELA MINTZ JEFFRIES 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	PTH196	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	DB9027	OTHER	AL	RAILROAD MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1003819608	OTHER	AL	GROUP NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	515-40476	OTHER	AL	BCBS
5	7643921	OTHER	AL	AETNA

General Provider Information

NPI Number	:	1730208620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA MINTZ JEFFRIES PT

Provider Business Mailing Address
First Line	:	1908 FLINT RD SE
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-6031
Country	:	US
Telephone Number	:	256-340-9708
Fax Number	:	256-340-9624

Provider Business Practice Location Address
First Line	:	208 OFFICE PARK DR
Second Line	:
City	:	GULF SHORES
State	:	AL
Zip	:	36542-3432
Country	:	US
Telephone Number	:	251-948-2045
Fax Number	:	251-948-2048

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	03/27/2009

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Directions to “ PAMELA MINTZ JEFFRIES PT” Practice Location

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