Provider Demographics
NPI:1861407280
Name:ARBOUR, PAMELA T (RPT)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:T
Last Name:ARBOUR
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 MAXWELL RD
Mailing Address - Street 2:
Mailing Address - City:MONSON
Mailing Address - State:MA
Mailing Address - Zip Code:01057-9438
Mailing Address - Country:US
Mailing Address - Phone:413-427-4778
Mailing Address - Fax:
Practice Address - Street 1:179 MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1259
Practice Address - Country:US
Practice Address - Phone:508-347-8141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAARY68143Medicare ID - Type Unspecified