Provider Demographics
NPI:1528776689
Name:REW, PAMELA K
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:K
Last Name:REW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 9TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-2343
Mailing Address - Country:US
Mailing Address - Phone:507-521-1838
Mailing Address - Fax:
Practice Address - Street 1:1260 STATE ST N
Practice Address - Street 2:
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-2706
Practice Address - Country:US
Practice Address - Phone:507-521-1838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN30-0346705OtherMASSAGE