Provider Demographics
NPI:1053638346
Name:PAMI, UNKNOWN (LMT KENTUCKY #0048)
Entity Type:Individual
Prefix:
First Name:UNKNOWN
Middle Name:
Last Name:PAMI
Suffix:
Gender:F
Credentials:LMT KENTUCKY #0048
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 ARTERBURN DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4855
Mailing Address - Country:US
Mailing Address - Phone:502-314-3254
Mailing Address - Fax:
Practice Address - Street 1:116 ARTERBURN DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4855
Practice Address - Country:US
Practice Address - Phone:502-314-3254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0048225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist