Provider Demographics
NPI:1124677745
Name:MARCHESE, PAMELA CHRISTINE (PT, DPT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:CHRISTINE
Last Name:MARCHESE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:CHRISTINE
Other - Last Name:MACHESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:16615 LARK AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-7645
Mailing Address - Country:US
Mailing Address - Phone:408-358-1460
Mailing Address - Fax:
Practice Address - Street 1:16615 LARK AVE STE 101
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-7645
Practice Address - Country:US
Practice Address - Phone:408-358-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT2970492081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine