Provider Demographics
NPI:1609189208
Name:BRESHEARS, PAMELA J (PT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:BRESHEARS
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 1:1475 KISKER RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8781
Mailing Address - Country:US
Mailing Address - Phone:636-498-7474
Mailing Address - Fax:636-498-7475
Practice Address - Street 1:1475 KISKER RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-8781
Practice Address - Country:US
Practice Address - Phone:636-498-7474
Practice Address - Fax:636-498-7475
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist