Provider Demographics
NPI:1548346638
Name:DIDOMENICO, PAMELA LYNN (PT)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:LYNN
Last Name:DIDOMENICO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:LYNN
Other - Last Name:HELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1515 S NEGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1419
Mailing Address - Country:US
Mailing Address - Phone:412-422-3755
Mailing Address - Fax:724-444-5335
Practice Address - Street 1:5465 WILLIAM FLYNN HWY
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9696
Practice Address - Country:US
Practice Address - Phone:724-444-5333
Practice Address - Fax:724-444-5335
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013105L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist