Provider Demographics
NPI:1245573906
Name:PANAGOPOULOS, PAMELA (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:PANAGOPOULOS
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 CENTER BLVD APT 1508
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5755
Mailing Address - Country:US
Mailing Address - Phone:310-220-1132
Mailing Address - Fax:
Practice Address - Street 1:1723 8TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6103
Practice Address - Country:US
Practice Address - Phone:718-290-2739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0361692251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics