Provider Demographics
NPI:1356850606
Name:SPILLETT, PAMELA R (PT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:SPILLETT
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 1:8036 EXPLORATION AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-4599
Mailing Address - Country:US
Mailing Address - Phone:702-767-7591
Mailing Address - Fax:
Practice Address - Street 1:8036 EXPLORATION AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-4599
Practice Address - Country:US
Practice Address - Phone:702-767-7591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist