Provider Demographics
NPI:1073623666
Name:GJERDE, PAMELA ELENE (PT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ELENE
Last Name:GJERDE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 DRUID HILLS RESERVE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2056
Mailing Address - Country:US
Mailing Address - Phone:678-371-3688
Mailing Address - Fax:
Practice Address - Street 1:57 EXECUTIVE PARK SOUTH NE
Practice Address - Street 2:STE 190
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2288
Practice Address - Country:US
Practice Address - Phone:404-778-6390
Practice Address - Fax:404-778-6340
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT008073OtherLICENSE #