Provider Demographics
NPI:1205122017
Name:BLENDERMANN, PAMELA JEAN (PT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:BLENDERMANN
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 1:1939 MINNEHAHA AVE W STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1033
Mailing Address - Country:US
Mailing Address - Phone:651-748-4338
Mailing Address - Fax:651-748-2892
Practice Address - Street 1:23490 HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:MN
Practice Address - Zip Code:55331-3141
Practice Address - Country:US
Practice Address - Phone:612-888-9882
Practice Address - Fax:612-888-9886
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist