Provider Demographics
NPI:1629332366
Name:BEAN, PAMELA A (CMT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:BEAN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 STANIFORD RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05408-2437
Mailing Address - Country:US
Mailing Address - Phone:802-233-4733
Mailing Address - Fax:
Practice Address - Street 1:132 PEARL ST STE 101
Practice Address - Street 2:
Practice Address - City:ESSEX JCT
Practice Address - State:VT
Practice Address - Zip Code:05452-3642
Practice Address - Country:US
Practice Address - Phone:802-233-4733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist