Provider Demographics
NPI:1487904397
Name:MIKITA, PAMELA ELIZABETH (PTA)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ELIZABETH
Last Name:MIKITA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2486 N PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2376
Mailing Address - Country:US
Mailing Address - Phone:805-484-5447
Mailing Address - Fax:805-484-2158
Practice Address - Street 1:2486 N PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2376
Practice Address - Country:US
Practice Address - Phone:805-484-5447
Practice Address - Fax:805-484-2158
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 4438225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant