Provider Demographics
NPI:1003212291
Name:VENEGAS, PATRICIA (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:VENEGAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 N FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3618
Mailing Address - Country:US
Mailing Address - Phone:626-696-1400
Mailing Address - Fax:626-696-1450
Practice Address - Street 1:440 E HUNTINGTON DR
Practice Address - Street 2:SUITE 104
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3776
Practice Address - Country:US
Practice Address - Phone:626-623-1122
Practice Address - Fax:626-623-1130
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist