Provider Demographics
NPI:1083601660
Name:PEDUTO, PAMELA (PT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:PEDUTO
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 1:219 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-4431
Mailing Address - Country:US
Mailing Address - Phone:570-668-1889
Mailing Address - Fax:570-668-6115
Practice Address - Street 1:219 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-4431
Practice Address - Country:US
Practice Address - Phone:570-668-1889
Practice Address - Fax:570-668-6115
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006263L225100000X
2251G0304X, 2251X0800X, 2251P0200X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
11454369OtherCAQH
2001144OtherKEYSTONE
3732909OtherAETNA HMO
4457139OtherAETNA PPO
818899OtherFIRST PRIORITY HEALTH
00194863OtherRAILROAD MEDICARE
257171OtherHEALTH ASSURANCE
1676332OtherHIGHMARK BLUE SHIELD
50044273OtherCAPITAL BLUE CROSS
00194863OtherRAILROAD MEDICARE
Q35088Medicare UPIN