Provider Demographics
NPI:1164619334
Name:BASA, PAMELA F (PT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:F
Last Name:BASA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:M
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5255 WILLOW WALK RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-1925
Mailing Address - Country:US
Mailing Address - Phone:760-687-3542
Mailing Address - Fax:
Practice Address - Street 1:5255 WILLOW WALK RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-1925
Practice Address - Country:US
Practice Address - Phone:760-687-3542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist