Provider Demographics
NPI:1598246589
Name:NANCE, PAMELA DENISE (PTA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DENISE
Last Name:NANCE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:D
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:193 SAGEMORE RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8494
Mailing Address - Country:US
Mailing Address - Phone:705-507-0135
Mailing Address - Fax:
Practice Address - Street 1:548 WHITE OAKS DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-8183
Practice Address - Country:US
Practice Address - Phone:704-507-0135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC823225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant