Provider Demographics
NPI:1497744296
Name:SKONORD, PAMELA L (PT, ATC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:SKONORD
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 COMMONS WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1906
Mailing Address - Country:US
Mailing Address - Phone:406-756-2555
Mailing Address - Fax:406-756-2558
Practice Address - Street 1:115 COMMONS WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1906
Practice Address - Country:US
Practice Address - Phone:406-756-2555
Practice Address - Fax:406-756-2558
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT560PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0197817OtherWA STATE WORK COMP
MT3401281Medicaid
MT60553OtherBCBS PROVIDER #
MTMSF1244881OtherMT STATE FUND WORK COMP
MT3401281Medicaid