Provider Demographics
NPI:1215188974
Name:CRAFT, PAMELA MICHELE (PT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MICHELE
Last Name:CRAFT
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 1:3101 DENNY AVE
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5307
Mailing Address - Country:US
Mailing Address - Phone:228-471-1544
Mailing Address - Fax:228-471-1548
Practice Address - Street 1:3101 DENNY AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5307
Practice Address - Country:US
Practice Address - Phone:228-471-1544
Practice Address - Fax:228-471-1548
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist