Provider Demographics
NPI:1336467141
Name:GILL, PAMELA PATRICIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:PATRICIA
Last Name:GILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:PATRICIA
Other - Last Name:JESSAMY GILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:298 FENIMORE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-5904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:298 FENIMORE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5904
Practice Address - Country:US
Practice Address - Phone:718-930-5223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist