Provider Demographics
NPI:1982879086
Name:ANDERSON, PAMELA LEIGH (RPT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LEIGH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 TANGLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5737
Mailing Address - Country:US
Mailing Address - Phone:706-215-0649
Mailing Address - Fax:706-335-5383
Practice Address - Street 1:1131 TANGLEBROOK DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5737
Practice Address - Country:US
Practice Address - Phone:706-215-0649
Practice Address - Fax:706-335-5383
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist