Provider Demographics
NPI:1477598498
Name:REYNOLDS, PAMELA F (PT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:F
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:F
Other - Last Name:CRAVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5627 NW 86TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1738
Mailing Address - Country:US
Mailing Address - Phone:515-270-0303
Mailing Address - Fax:515-270-0160
Practice Address - Street 1:5627 NW 86TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1738
Practice Address - Country:US
Practice Address - Phone:515-270-0303
Practice Address - Fax:515-270-0160
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
I12709004Medicare PIN