Provider Demographics
NPI:1790750263
Name:VASIL, PAMELA M (PT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:VASIL
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 1:300 STATE ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1427
Mailing Address - Country:US
Mailing Address - Phone:814-454-5251
Mailing Address - Fax:814-459-1884
Practice Address - Street 1:300 STATE ST
Practice Address - Street 2:SUITE 209
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1427
Practice Address - Country:US
Practice Address - Phone:814-454-5251
Practice Address - Fax:814-459-1884
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000681E225100000X
PADAPT000362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028787420001Medicaid
PA1028787420001Medicaid