Provider Demographics
NPI:1235326315
Name:SILLS, PAMELA K (CMT, HHP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:SILLS
Suffix:
Gender:F
Credentials:CMT, HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 FOUNTAIN DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-5324
Mailing Address - Country:US
Mailing Address - Phone:219-736-9262
Mailing Address - Fax:219-736-9264
Practice Address - Street 1:5201 FOUNTAIN DR
Practice Address - Street 2:SUITE F
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-5324
Practice Address - Country:US
Practice Address - Phone:219-736-9262
Practice Address - Fax:219-736-9264
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist