Provider Demographics
NPI:1164545851
Name:RIEDEMAN, PAMELA J (LPT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:RIEDEMAN
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 E LUTZ RD
Mailing Address - Street 2:
Mailing Address - City:ARCHBOLD
Mailing Address - State:OH
Mailing Address - Zip Code:43502-3211
Mailing Address - Country:US
Mailing Address - Phone:419-446-9144
Mailing Address - Fax:419-446-9146
Practice Address - Street 1:815 E LUTZ RD
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502-3211
Practice Address - Country:US
Practice Address - Phone:419-446-9144
Practice Address - Fax:419-446-9146
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH005439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0769861Medicare PIN