Provider Demographics
NPI:1467723817
Name:QUINTANILLA, PAMELA REINHARDT (PTA)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:REINHARDT
Last Name:QUINTANILLA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:REINHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:413 POWELL AVE
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029-4124
Mailing Address - Country:US
Mailing Address - Phone:806-717-9732
Mailing Address - Fax:
Practice Address - Street 1:515 E 1ST ST
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-3219
Practice Address - Country:US
Practice Address - Phone:806-934-2634
Practice Address - Fax:806-934-2636
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2016622225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant