Provider Demographics
NPI:1316044423
Name:MINNIS, PAMELA A (PT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:A
Last Name:MINNIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:A
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1703
Mailing Address - Street 2:
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719
Mailing Address - Country:US
Mailing Address - Phone:732-681-1122
Mailing Address - Fax:732-681-0999
Practice Address - Street 1:2510 BELMAR BLVD
Practice Address - Street 2:COLFAX PLAZA
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719-3948
Practice Address - Country:US
Practice Address - Phone:732-681-1122
Practice Address - Fax:732-681-0999
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00255300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ805936Medicare ID - Type Unspecified