Provider Demographics
NPI:1235536830
Name:MOOTY, PAMELA S
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:MOOTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:S
Other - Last Name:VEERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1917 ABBOTT RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3449
Mailing Address - Country:US
Mailing Address - Phone:907-743-8218
Mailing Address - Fax:907-743-8283
Practice Address - Street 1:3051 E PALMER WASILLA HWY
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7234
Practice Address - Country:US
Practice Address - Phone:907-376-8590
Practice Address - Fax:907-376-8584
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist