Individual
MS. PAMELA MICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7127 LATOUR CT, ALEXANDRIA, VA 22315-3958
(703) 768-1928
Mailing address
7127 LATOUR CT, ALEXANDRIA, VA 22315-3958
(703) 768-1928
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306602006
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2306602006
STATE OF VIRGINIA
VA
Enumeration date
08/10/2009
Last updated
08/10/2009
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