Individual
PAMELA THAYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1000 EDDY STREET, PROVIDENCE, RI 02905
(401) 533-9100
Mailing address
1000 EDDY STREET, PROVIDENCE, RI 02905
(401) 533-9100
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT00413
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2058
SS NHPRC
RI
01
—
2092
EI NHPRC
RI
01
—
292177
EI BCROSS
RI
01
—
407220
SS BCHIP
RI
01
—
412296
EI BCHIP
RI
01
—
6400144
SS/EI UHP
RI
01
—
99947
SS BCROSS
RI
Enumeration date
07/03/2006
Last updated
07/08/2007
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