Provider Demographics
NPI:1821217753
Name:MALICOAT, PAMELA SUE (PT)
Entity Type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:SUE
Last Name:MALICOAT
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 1:3218 CHERRYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7617
Mailing Address - Country:US
Mailing Address - Phone:214-793-5007
Mailing Address - Fax:
Practice Address - Street 1:3218 CHERRYWOOD AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7617
Practice Address - Country:US
Practice Address - Phone:214-793-5007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1032035225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist