Provider Demographics
NPI:1295136364
Name:MURGO, PAMELA (LMT)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:MURGO
Suffix:
Gender:F
Credentials:LMT
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 1089
Mailing Address - Street 2:1187 PUTNAM PIKE
Mailing Address - City:CHEPACHET
Mailing Address - State:RI
Mailing Address - Zip Code:02814
Mailing Address - Country:US
Mailing Address - Phone:401-569-8080
Mailing Address - Fax:
Practice Address - Street 1:1187 PUTNAM PIKE
Practice Address - Street 2:
Practice Address - City:CHEPACHET
Practice Address - State:RI
Practice Address - Zip Code:02814-1962
Practice Address - Country:US
Practice Address - Phone:401-569-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMT01848225700000X
MA9619-MT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist