Provider Demographics
NPI:1659560993
Name:RADZIEWICZ, PAMELA ANNE (MPT)
Entity Type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:ANNE
Last Name:RADZIEWICZ
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 VERNONICA AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873
Mailing Address - Country:US
Mailing Address - Phone:732-246-7600
Mailing Address - Fax:732-246-8078
Practice Address - Street 1:49 VERNONICA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-246-7600
Practice Address - Fax:732-246-8078
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01255800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist