Provider Demographics
NPI:1982941993
Name:MICHAEL, PAMELA
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 CHICKENBRISTLE RD
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45325-9231
Mailing Address - Country:US
Mailing Address - Phone:937-696-2979
Mailing Address - Fax:
Practice Address - Street 1:101 MILLS PLACE
Practice Address - Street 2:NEW LEBANON CARE AND REHAB CENTER
Practice Address - City:NEW LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45345
Practice Address - Country:US
Practice Address - Phone:937-687-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN5887225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant