Provider Demographics
NPI:1063659597
Name:CORMIER, PAMELA (RPT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:CORMIER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:PROTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAMELA CORMIER
Mailing Address - Street 1:88 WINTERGREEN CIR
Mailing Address - Street 2:
Mailing Address - City:OSTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02655-1516
Mailing Address - Country:US
Mailing Address - Phone:774-238-8304
Mailing Address - Fax:
Practice Address - Street 1:255 INDUSTRIAL DRIVE
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02635
Practice Address - Country:US
Practice Address - Phone:774-487-0783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist