Provider Demographics
NPI:1093701716
Name:RHONE, PAMELA LASSITER
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LASSITER
Last Name:RHONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:MARIE
Other - Last Name:LASSITER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14205 PARK CENTER DR
Mailing Address - Street 2:STE 204
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5252
Mailing Address - Country:US
Mailing Address - Phone:301-853-0093
Mailing Address - Fax:301-853-0096
Practice Address - Street 1:14205 PARK CENTER DR
Practice Address - Street 2:STE 204
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5252
Practice Address - Country:US
Practice Address - Phone:301-853-0093
Practice Address - Fax:301-853-0096
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD796604100Medicaid