Provider Demographics
NPI:1851752299
Name:VIERRA, PAMELA (LMT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:VIERRA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:VIERRA
Other - Last Name:ZILLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:7859 5 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-9451
Mailing Address - Country:US
Mailing Address - Phone:248-912-2045
Mailing Address - Fax:
Practice Address - Street 1:7859 5 MILE RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-9451
Practice Address - Country:US
Practice Address - Phone:248-912-2045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-13
Last Update Date:2016-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501004797225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist