Provider Demographics
NPI:1730483678
Name:ELLIOTT, PAMELA R (MSPT)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:R
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5503
Mailing Address - Country:US
Mailing Address - Phone:757-460-3363
Mailing Address - Fax:757-460-1809
Practice Address - Street 1:1024 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5503
Practice Address - Country:US
Practice Address - Phone:757-460-3363
Practice Address - Fax:757-460-1809
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist