Provider Demographics
NPI:1336518760
Name:PAMILOZA, TYRONE (PT)
Entity Type:Individual
Prefix:
First Name:TYRONE
Middle Name:
Last Name:PAMILOZA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2084 N 1700 W
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1100
Mailing Address - Country:US
Mailing Address - Phone:385-419-7379
Mailing Address - Fax:
Practice Address - Street 1:1100 S 2000 E APT E239
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1485
Practice Address - Country:US
Practice Address - Phone:385-419-7379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT93762922401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist