1760645212 NPI number — SARAH JANETTE PATTERSON P.T.

Table of content: (NPI 1154421089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760645212 NPI number — SARAH JANETTE PATTERSON P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATTERSON
Provider First Name:
SARAH
Provider Middle Name:
JANETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760645212
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2008 MANNING PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA GRANGE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40031-8993
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-222-9137
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6003 PLEASANT COLONY CT
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
CRESTWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40014-8678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-241-5597
Provider Business Practice Location Address Fax Number:
502-241-6499
Provider Enumeration Date:
07/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  004062 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)