Provider Demographics
NPI:1851432827
Name:SCHMITT-MATZEN, PAMELA DOREEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:DOREEN
Last Name:SCHMITT-MATZEN
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 1:132 S LOWE AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4701
Mailing Address - Country:US
Mailing Address - Phone:931-526-3151
Mailing Address - Fax:931-526-4051
Practice Address - Street 1:132 S LOWE AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4701
Practice Address - Country:US
Practice Address - Phone:931-526-3151
Practice Address - Fax:931-526-4051
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000000945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3654695Medicare ID - Type Unspecified