Provider Demographics
NPI:1386025195
Name:POPE, PAMELA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:POPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 GALE HILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12060-1913
Mailing Address - Country:US
Mailing Address - Phone:518-794-8676
Mailing Address - Fax:
Practice Address - Street 1:506 GALE HILL RD
Practice Address - Street 2:
Practice Address - City:EAST CHATHAM
Practice Address - State:NY
Practice Address - Zip Code:12060-1913
Practice Address - Country:US
Practice Address - Phone:518-794-8676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist