Provider Demographics
NPI:1871790972
Name:PERAULT, PAMELA J (MS, PT)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:J
Last Name:PERAULT
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3157 39TH AVE.
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601
Mailing Address - Country:US
Mailing Address - Phone:402-564-4091
Mailing Address - Fax:
Practice Address - Street 1:3100 23RD ST
Practice Address - Street 2:SUITE 15
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-3161
Practice Address - Country:US
Practice Address - Phone:402-562-7346
Practice Address - Fax:402-562-8331
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist