Basic Information
| Provider Information | |||||||||
| NPI: | 1750420220 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELLISON | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | MCGLOTHLIN | ||||||||
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| Credential: | RN PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 BB SAMS DR | ||||||||
| Address2: | |||||||||
| City: | SAINT HELENA ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299203010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438383325 | ||||||||
| FaxNumber: | 8438383325 | ||||||||
| Practice Location | |||||||||
| Address1: | 1941 SAVAGE RD | ||||||||
| Address2: | SUITE 400C | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294074704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8665712700 | ||||||||
| FaxNumber: | 8775712124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R 83691 | SC | X | Nursing Service Providers | Registered Nurse | 225200000X | 1610 | SC | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | 2306601404 | VA | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.