Provider Demographics
NPI:1851062830
Name:DICKEY, PAMELA LOU (LPTA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LOU
Last Name:DICKEY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11319 AUTUMN WIND LOOP
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6434
Mailing Address - Country:US
Mailing Address - Phone:352-989-7326
Mailing Address - Fax:
Practice Address - Street 1:11319 AUTUMN WIND LOOP
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6434
Practice Address - Country:US
Practice Address - Phone:352-989-6326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA1957225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant