Provider Demographics
NPI:1396068987
Name:ITALIA, PAMELA F (PT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:F
Last Name:ITALIA
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 1:19201 MONTGOMERY VILLAGE AVE
Mailing Address - Street 2:SUITE A-11
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-5027
Mailing Address - Country:US
Mailing Address - Phone:301-948-2414
Mailing Address - Fax:301-948-0597
Practice Address - Street 1:19201 MONTGOMERY VILLAGE AVE
Practice Address - Street 2:SUITE A-11
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-5027
Practice Address - Country:US
Practice Address - Phone:301-948-2414
Practice Address - Fax:301-948-0597
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist