Provider Demographics
NPI:1063061760
Name:SOTO, PAMELA (PT, DPT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:SOTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:4153 NORTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716
Mailing Address - Country:US
Mailing Address - Phone:301-464-1893
Mailing Address - Fax:301-464-1824
Practice Address - Street 1:4153 NORTHVIEW DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716
Practice Address - Country:US
Practice Address - Phone:301-464-1893
Practice Address - Fax:301-464-1824
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT6560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherPT-6560