Provider Demographics
NPI:1669600037
Name:PANTUSO, AIMEE M (PT)
Entity type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:M
Last Name:PANTUSO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:M
Other - Last Name:PARISEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1511 TEXAS AVE S
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-3328
Mailing Address - Country:US
Mailing Address - Phone:904-891-7025
Mailing Address - Fax:
Practice Address - Street 1:800 SCOTT AND WHITE DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845
Practice Address - Country:US
Practice Address - Phone:979-207-4000
Practice Address - Fax:979-207-4562
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1081776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist