Provider Demographics
NPI:1467286732
Name:WALLACE, PAMELA LINDSEY (PT, DPT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:LINDSEY
Last Name:WALLACE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15109 HEATHROW FOREST PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77032-3917
Mailing Address - Country:US
Mailing Address - Phone:281-801-4650
Mailing Address - Fax:281-801-4601
Practice Address - Street 1:15109 HEATHROW FOREST PKWY STE 130
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-3917
Practice Address - Country:US
Practice Address - Phone:281-801-4650
Practice Address - Fax:281-801-4601
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1343999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist