Provider Demographics
NPI:1871666354
Name:SMELTZ, PAMELA SUE (MSPT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:SMELTZ
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 64C
Mailing Address - Street 2:SMELTZ ROAD
Mailing Address - City:DORNSIFE
Mailing Address - State:PA
Mailing Address - Zip Code:17823-9786
Mailing Address - Country:US
Mailing Address - Phone:570-758-2467
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 52B
Practice Address - Street 2:ROUTE 225
Practice Address - City:DORNSIFE
Practice Address - State:PA
Practice Address - Zip Code:17823-9724
Practice Address - Country:US
Practice Address - Phone:570-758-4179
Practice Address - Fax:570-758-4179
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002127E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01994901OtherBLUE CROSS
PA01994901OtherBLUE CROSS