Provider Demographics
NPI:1497967335
Name:MILLER, PAMELA R (PTA)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 WATTAQUADOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01740-1233
Mailing Address - Country:US
Mailing Address - Phone:978-634-1046
Mailing Address - Fax:
Practice Address - Street 1:619 WATTAQUADOCK HILL RD
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:MA
Practice Address - Zip Code:01740-1233
Practice Address - Country:US
Practice Address - Phone:978-634-1046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2422225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant