Provider Demographics
NPI:1033550967
Name:IAPICCA, PAMELA JEAN
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:IAPICCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:185 SQUIRE RD
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-1234
Mailing Address - Country:US
Mailing Address - Phone:178-128-4055
Mailing Address - Fax:178-128-4069
Practice Address - Street 1:185 SQUIRE RD
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-1234
Practice Address - Country:US
Practice Address - Phone:178-128-4055
Practice Address - Fax:178-128-4069
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA952225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant