Provider Demographics
NPI:1710234414
Name:WOODSIDE, PAMELA LEE (DPT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LEE
Last Name:WOODSIDE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 MOUNTAIN ASH CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8955
Mailing Address - Country:US
Mailing Address - Phone:615-767-3800
Mailing Address - Fax:
Practice Address - Street 1:9720 MOUNTAIN ASH CT
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8955
Practice Address - Country:US
Practice Address - Phone:615-767-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN76472251P0200X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No251E00000XAgenciesHome Health