Provider Demographics
NPI:1649299835
Name:BANNING, PAMELA ANN (PT)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ANN
Last Name:BANNING
Suffix:
Gender:F
Credentials:PT
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Other - First Name:
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Mailing Address - Street 1:17233 N HOLMES BLVD
Mailing Address - Street 2:SUITE 1650
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-2018
Mailing Address - Country:US
Mailing Address - Phone:602-889-5200
Mailing Address - Fax:623-251-5661
Practice Address - Street 1:6309 E BAYWOOD AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1744
Practice Address - Country:US
Practice Address - Phone:602-889-5200
Practice Address - Fax:623-251-5661
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ77082Medicare PIN