Provider Demographics
NPI:1871609479
Name:MEYER, PAMELA J (PT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:MEYER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:J
Other - Last Name:CONNAHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 8004
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54402-8004
Mailing Address - Country:US
Mailing Address - Phone:715-847-2304
Mailing Address - Fax:
Practice Address - Street 1:3402 HOWLAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-5633
Practice Address - Country:US
Practice Address - Phone:715-355-5701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40201000Medicaid
WI001680038Medicare ID - Type Unspecified