Provider Demographics
NPI:1194774976
Name:ANTHONY, PAMELA L (MPT, ATC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:MPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ACCUCARE PHYSICAL THERAPY & SPORTS MEDICINE LLC
Mailing Address - Street 2:1610 ROUTE 88W., SUITE 103
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3018
Mailing Address - Country:US
Mailing Address - Phone:732-785-5500
Mailing Address - Fax:732-785-5501
Practice Address - Street 1:ACCUCARE PHYSICAL THERAPY & SPORTS MEDICINE LLC
Practice Address - Street 2:1610 ROUTE 88W., SUITE 103
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3018
Practice Address - Country:US
Practice Address - Phone:732-785-5500
Practice Address - Fax:732-785-5501
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00972200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ055411Medicare ID - Type Unspecified