Provider Demographics
NPI:1316490782
Name:SAXON, PAMELA (PT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:SAXON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:KREUTHMEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:815 BLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-2407
Mailing Address - Country:US
Mailing Address - Phone:262-632-3035
Mailing Address - Fax:
Practice Address - Street 1:1600 OHIO ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-3157
Practice Address - Country:US
Practice Address - Phone:262-995-7291
Practice Address - Fax:262-995-7292
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist