Provider Demographics
NPI:1730208620
Name:JEFFRIES, PAMELA MINTZ (PT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MINTZ
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 FLINT RD SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6031
Mailing Address - Country:US
Mailing Address - Phone:256-340-9708
Mailing Address - Fax:256-340-9624
Practice Address - Street 1:208 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-3432
Practice Address - Country:US
Practice Address - Phone:251-948-2045
Practice Address - Fax:251-948-2048
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1003819608OtherGROUP NPI
AL890021030Medicaid
AL515-40476OtherBCBS
ALDB9027OtherRAILROAD MEDICARE GROUP
AL7643921OtherAETNA
AL7643921OtherAETNA
AL890021030Medicaid