Provider Demographics
NPI:1972861110
Name:JOOSTEN, PAMALA SUE (LMT,CMT,NCTMB,MC)
Entity type:Individual
Prefix:MS
First Name:PAMALA
Middle Name:SUE
Last Name:JOOSTEN
Suffix:
Gender:F
Credentials:LMT,CMT,NCTMB,MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N WILMOT RD
Mailing Address - Street 2:103
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2618
Mailing Address - Country:US
Mailing Address - Phone:520-551-3497
Mailing Address - Fax:520-208-9009
Practice Address - Street 1:310 N WILMOT RD
Practice Address - Street 2:103
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2618
Practice Address - Country:US
Practice Address - Phone:520-551-3497
Practice Address - Fax:520-208-9009
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ515790-06225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist