Individual
PAMELA VERSAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
111 NORTH 20TH, PHILOMATH, OR 97370
(541) 368-4313
Mailing address
PO BOX 455, 111 NORTH 20TH, PHILOMATH, OR 97370-0455
(541) 368-4313
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
61376
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144737614
—
OR
Enumeration date
11/23/2015
Last updated
11/23/2015
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