Provider Demographics
NPI:1659407831
Name:BEAVERS, PAMELA A (PT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:BEAVERS
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 1:2308 RADBURY LN
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6121
Mailing Address - Country:US
Mailing Address - Phone:770-596-5551
Mailing Address - Fax:770-979-9757
Practice Address - Street 1:2308 RADBURY LN
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6121
Practice Address - Country:US
Practice Address - Phone:770-596-5551
Practice Address - Fax:770-979-9757
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006035225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist