Provider Demographics
NPI:1679853022
Name:EVERETT, PAMELA DIANE
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DIANE
Last Name:EVERETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:DIANE
Other - Last Name:MANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1094 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-1364
Mailing Address - Country:US
Mailing Address - Phone:865-458-8900
Mailing Address - Fax:865-458-8626
Practice Address - Street 1:1094 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1364
Practice Address - Country:US
Practice Address - Phone:865-458-8900
Practice Address - Fax:865-458-8626
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000602225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant