Provider Demographics
NPI:1689870925
Name:HARTLEY, PAMELA LEE (LPTA)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:LEE
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:LEE
Other - Last Name:CASAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1151 MIDDLETON PIKE
Mailing Address - Street 2:
Mailing Address - City:LUCKEY
Mailing Address - State:OH
Mailing Address - Zip Code:43443-9781
Mailing Address - Country:US
Mailing Address - Phone:419-837-6363
Mailing Address - Fax:419-837-6230
Practice Address - Street 1:1151 MIDDLETON PIKE
Practice Address - Street 2:
Practice Address - City:LUCKEY
Practice Address - State:OH
Practice Address - Zip Code:43443-9781
Practice Address - Country:US
Practice Address - Phone:419-837-6363
Practice Address - Fax:419-837-6230
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05501225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant