Provider Demographics
NPI:1013979020
Name:MORETTA, PAMELA (PT,CHT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:MORETTA
Suffix:
Gender:F
Credentials:PT,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4426 WHIPPLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2646
Mailing Address - Country:US
Mailing Address - Phone:330-492-1222
Mailing Address - Fax:330-492-1382
Practice Address - Street 1:4426 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2646
Practice Address - Country:US
Practice Address - Phone:330-492-1222
Practice Address - Fax:330-492-1382
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT0028242251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCM0529OtherMEDICARE ID TYPE UNSPEC
OHCM0529OtherMEDICARE ID TYPE UNSPEC