Provider Demographics
NPI:1154380293
Name:MARTIN, PAMELA A (PT ATC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT ATC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1673 W SHORELINE DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6750
Mailing Address - Country:US
Mailing Address - Phone:208-343-4700
Mailing Address - Fax:208-343-4706
Practice Address - Street 1:1618 MILLENIUM WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6439
Practice Address - Country:US
Practice Address - Phone:208-884-4647
Practice Address - Fax:208-884-8984
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2009-06-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDPT1850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist