Provider Demographics
NPI:1740362151
Name:BURNS, PAMELA (PT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:BURNS
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 1:151 BLAIR PARK RD
Mailing Address - Street 2:PO BOX 1064
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7435
Mailing Address - Country:US
Mailing Address - Phone:802-879-0909
Mailing Address - Fax:802-879-3095
Practice Address - Street 1:151 BLAIR PARK RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7435
Practice Address - Country:US
Practice Address - Phone:802-879-0909
Practice Address - Fax:802-879-3095
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002826225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT030281196005OtherTRICARE
VT1007599Medicaid
VT43V027OtherMVP
VT00028483OtherBC/BS
VT272921OtherCIGNA
VT43V027OtherMVP