Provider Demographics
NPI:1053453472
Name:PAMELA BOOKOUT, PRT PC
Entity Type:Organization
Organization Name:PAMELA BOOKOUT, PRT PC
Other - Org Name:PHYSICAL THERAPY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SCHULTHEISS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA (INACTIVE), MS
Authorized Official - Phone:423-622-2402
Mailing Address - Street 1:PO BOX 1566
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-1566
Mailing Address - Country:US
Mailing Address - Phone:423-622-2402
Mailing Address - Fax:423-622-8778
Practice Address - Street 1:503 S GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5028
Practice Address - Country:US
Practice Address - Phone:423-622-2402
Practice Address - Fax:423-622-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3654784Medicare ID - Type Unspecified