Provider Demographics
NPI:1851335483
Name:ST. CLAIR, PAMELA J (PT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:ST. CLAIR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:J
Other - Last Name:HESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4000 N PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8018
Mailing Address - Country:US
Mailing Address - Phone:920-257-2000
Mailing Address - Fax:920-257-2004
Practice Address - Street 1:1620 N SHAWANO ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-9368
Practice Address - Country:US
Practice Address - Phone:920-982-3670
Practice Address - Fax:920-982-4273
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10309-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40461300Medicaid
WI001086160Medicare ID - Type Unspecified
WI40461300Medicaid
WI001086030Medicare ID - Type Unspecified