Provider Demographics
NPI:1457768269
Name:BECKER, PAMELA JAMES (PT)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JAMES
Last Name:BECKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:JAMES
Other - Last Name:COKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3050 CENTRE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1102
Mailing Address - Country:US
Mailing Address - Phone:651-631-4242
Mailing Address - Fax:651-631-4260
Practice Address - Street 1:3050 CENTRE POINTE DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1102
Practice Address - Country:US
Practice Address - Phone:651-631-4242
Practice Address - Fax:651-631-4260
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist