Provider Demographics
NPI:1366689549
Name:MAGGIACOMO, PAMELA JOY (RPT,LMT)
Entity type:Individual
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First Name:PAMELA
Middle Name:JOY
Last Name:MAGGIACOMO
Suffix:
Gender:F
Credentials:RPT,LMT
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Other - Middle Name:
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Mailing Address - Street 1:5000 ELLINGHOUSE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COOL
Mailing Address - State:CA
Mailing Address - Zip Code:95614-9568
Mailing Address - Country:US
Mailing Address - Phone:530-887-9598
Mailing Address - Fax:530-887-9512
Practice Address - Street 1:5000 ELLINGHOUSE DR STE 100
Practice Address - Street 2:
Practice Address - City:COOL
Practice Address - State:CA
Practice Address - Zip Code:95614-9568
Practice Address - Country:US
Practice Address - Phone:530-887-9598
Practice Address - Fax:530-887-9512
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3195225100000X
CAPT33325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist