Provider Demographics
NPI:1225519366
Name:MARTIN, PAMELA CHRISTINE (RPT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:CHRISTINE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 VERDE TRL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7702
Mailing Address - Country:US
Mailing Address - Phone:561-451-3915
Mailing Address - Fax:561-451-3910
Practice Address - Street 1:6363 VERDE TRL
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7702
Practice Address - Country:US
Practice Address - Phone:561-451-3915
Practice Address - Fax:561-451-3910
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist