Provider Demographics
NPI:1639194327
Name:FAUST, PAMELA M (PT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:FAUST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:M
Other - Last Name:KARNIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9735 SOUTHWEST HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-499-4497
Mailing Address - Fax:
Practice Address - Street 1:9735 SOUTHWEST HIGHWAY
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-499-4497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL367885100OtherUS DEPT OF LABOR
IL1619908OtherBCBS IL GROUP NUMBER
IL1623066OtherBCBS PROVIDER NUMBER
IL568080OtherMEDICARE GROUP NUMBER
IL568080OtherMEDICARE GROUP NUMBER
IL367885100OtherUS DEPT OF LABOR
IL1623066OtherBCBS PROVIDER NUMBER
IL567770Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
IL1619908OtherBCBS IL GROUP NUMBER
IL202542Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
ILP00227479Medicare PIN
IL200852Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
ILCJ4383Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP
ILK01270Medicare PIN