Provider Demographics
NPI:1588859607
Name:STUPPY, PAMELA BENNETT (PT)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:BENNETT
Last Name:STUPPY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3339 BENNETT DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1703
Mailing Address - Country:US
Mailing Address - Phone:323-876-3339
Mailing Address - Fax:323-874-3338
Practice Address - Street 1:3339 BENNETT DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1703
Practice Address - Country:US
Practice Address - Phone:323-876-3339
Practice Address - Fax:323-874-3338
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist