MEDICARE: PAMELA FASHAW

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	21194	FL

General Provider Information

NPI Number	:	1942467618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA FASHAW

Provider Business Mailing Address
First Line	:	1191 E NEWPORT CENTER DR
Second Line	:	SUITE PH-J
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-7715
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1191 E NEWPORT CENTER DR
Second Line	:	SUITE PH-J
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-7715
Country	:	US
Telephone Number	:	954-379-1066
Fax Number	:

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

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	05/20/2008

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Directions to “ PAMELA FASHAW ” Practice Location

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