Provider Demographics
NPI:1154711893
Name:HIETANEN, PAMELA J (LPTA)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:HIETANEN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:J
Other - Last Name:HIETANEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:25001 EMERY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5627
Mailing Address - Country:US
Mailing Address - Phone:216-285-4070
Mailing Address - Fax:216-201-5230
Practice Address - Street 1:25001 EMERY RD
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5626
Practice Address - Country:US
Practice Address - Phone:216-285-4070
Practice Address - Fax:216-201-5230
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA.09434225200000X
OH33.013261225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1154711893OtherSELF-PAY