MEDICARE: PAMELA LARE PTA

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	A2937	MD

General Provider Information

NPI Number	:	1821940339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA LARE PTA

Provider Business Mailing Address
First Line	:	3601 EDGEMONT ST
Second Line	:
City	:	EDGEWATER
State	:	MD
Zip	:	21037-3525
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 MITCHELLVILLE RD STE 100
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20716-3122
Country	:	US
Telephone Number	:	410-544-6444
Fax Number	:

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

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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Directions to “ PAMELA LARE PTA” Practice Location

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