Provider Demographics
NPI:1710073341
Name:MORGAN, PAMELA J (PT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:MORGAN
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 1:22 LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011
Mailing Address - Country:US
Mailing Address - Phone:207-729-1164
Mailing Address - Fax:207-725-0905
Practice Address - Street 1:600 TURNER ST STE 2
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5093
Practice Address - Country:US
Practice Address - Phone:207-707-4788
Practice Address - Fax:833-702-9005
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME042407OtherBLUE SHIELD PROVIDER #
ME2463880099Medicaid
MEMM7844Medicare PIN