Provider Demographics
NPI:1801141783
Name:WESTDORP, PAMELA JOYCE (DPT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JOYCE
Last Name:WESTDORP
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S CLARK ST
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53050-1488
Mailing Address - Country:US
Mailing Address - Phone:920-387-1370
Mailing Address - Fax:
Practice Address - Street 1:305 S CLARK ST
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:WI
Practice Address - Zip Code:53050-1488
Practice Address - Country:US
Practice Address - Phone:920-387-1370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12079-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist