Provider Demographics
NPI:1285647560
Name:MARKERT, PAMELA D (PT)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:D
Last Name:MARKERT
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 1:99 WILSON POND RD
Mailing Address - Street 2:
Mailing Address - City:HARWINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06791-2814
Mailing Address - Country:US
Mailing Address - Phone:860-485-0830
Mailing Address - Fax:
Practice Address - Street 1:195 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1318
Practice Address - Country:US
Practice Address - Phone:860-225-0674
Practice Address - Fax:860-223-0033
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003469225100000X
NY019380-1225100000X
MAAH 5584-PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT08000469CT02OtherANTHEM BC/BS