Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT006263L | PA |
N | 2251G0304X | Physical Therapist - Geriatrics | ||
N | 2251P0200X | Physical Therapist - Pediatrics | ||
N | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1083601660 |
---|---|
Provider Name | Pamela Peduto |
First Address | Tamaqua, PA 18252-4431 |
Second Address | Tamaqua, PA 18252-4431 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 19/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00194863 | RAILROAD MEDICARE (01) | |
11454369 | CAQH (01) | |
1676332 | HIGHMARK BLUE SHIELD (01) | |
2001144 | KEYSTONE (01) | |
257171 | HEALTH ASSURANCE (01) | |
3732909 | AETNA HMO (01) | |
4457139 | AETNA PPO (01) | |
50044273 | CAPITAL BLUE CROSS (01) | |
818899 | FIRST PRIORITY HEALTH (01) | |
Q35088 | (02) |