Provider Demographics
NPI:1467451674
Name:GENTILE, PAMELA A (PT, MS, ATC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:GENTILE
Suffix:
Gender:F
Credentials:PT, MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 PENINSULA DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4261
Mailing Address - Country:US
Mailing Address - Phone:814-864-5097
Mailing Address - Fax:814-864-9583
Practice Address - Street 1:5100 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2482
Practice Address - Country:US
Practice Address - Phone:814-864-5097
Practice Address - Fax:814-864-9583
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001140E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
446239Medicare ID - Type Unspecified
R07004Medicare UPIN