Provider Demographics
NPI:1033267125
Name:WILLIS, PAMELA HOPE (LPTA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:HOPE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:HOPE
Other - Last Name:DOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:156 SCENIC RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-8245
Mailing Address - Country:US
Mailing Address - Phone:256-435-0221
Mailing Address - Fax:
Practice Address - Street 1:2300 COLEMAN RD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-6824
Practice Address - Country:US
Practice Address - Phone:256-831-5730
Practice Address - Fax:256-832-2004
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1489225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant