Provider Demographics
NPI:1255373239
Name:SILLS, PAMELA KONDRA (PT)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:KONDRA
Last Name:SILLS
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:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05464
Mailing Address - Country:US
Mailing Address - Phone:802-644-8011
Mailing Address - Fax:802-644-8047
Practice Address - Street 1:PO BOX 103
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05464-0103
Practice Address - Country:US
Practice Address - Phone:802-644-8011
Practice Address - Fax:802-644-8047
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008739Medicaid
VTVN2885Medicare PIN