Provider Demographics
NPI:1164538898
Name:DEHNE, PAMELA R (PT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:DEHNE
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 1:7454 CORDOBA CIR APT 211
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-2702
Mailing Address - Country:US
Mailing Address - Phone:512-590-1825
Mailing Address - Fax:
Practice Address - Street 1:4002 EXECUTIVE PARK BLVD STE 800
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-9069
Practice Address - Country:US
Practice Address - Phone:910-477-6357
Practice Address - Fax:910-477-6357
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1030658225100000X
NCCP008765T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G5682Medicare PIN
TX8K9825Medicare PIN