Provider Demographics
NPI:1760569511
Name:WAIN, PAMELA B (MPT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:B
Last Name:WAIN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 LAGUNARIA LN
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-6705
Mailing Address - Country:US
Mailing Address - Phone:415-235-7725
Mailing Address - Fax:
Practice Address - Street 1:502 LAGUNARIA LANE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94502
Practice Address - Country:US
Practice Address - Phone:415-235-7725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist