Provider Demographics
NPI:1417171596
Name:KONDRATKO, PAMELA R (PTA CWS)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:R
Last Name:KONDRATKO
Suffix:
Gender:F
Credentials:PTA CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 GENTLE DR
Mailing Address - Street 2:
Mailing Address - City:ALMO
Mailing Address - State:KY
Mailing Address - Zip Code:42020-9290
Mailing Address - Country:US
Mailing Address - Phone:270-753-7237
Mailing Address - Fax:
Practice Address - Street 1:300 S 8TH ST
Practice Address - Street 2:SUITE 403E
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2400
Practice Address - Country:US
Practice Address - Phone:270-762-1547
Practice Address - Fax:270-762-1889
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA000668225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant