Provider Demographics
NPI:1871696054
Name:SANDIFER, PAMELA LYNN (DPT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNN
Last Name:SANDIFER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:LYNN
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:116 E BLOOMINGDALE AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8101
Mailing Address - Country:US
Mailing Address - Phone:813-655-3342
Mailing Address - Fax:813-653-0894
Practice Address - Street 1:116 E BLOOMINGDALE AVENUE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8101
Practice Address - Country:US
Practice Address - Phone:813-655-3342
Practice Address - Fax:813-653-0894
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY908VOtherBLUE CROSS BLUE SHIELD
P00180015OtherRR RETIREMENT
FLY908VOtherBLUE CROSS BLUE SHIELD