Provider Demographics
NPI:1114107117
Name:DENIKE, PATTI (NCTMB THERAPIST)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:
Last Name:DENIKE
Suffix:
Gender:F
Credentials:NCTMB THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:LAKEMONT
Mailing Address - State:GA
Mailing Address - Zip Code:30552-0007
Mailing Address - Country:US
Mailing Address - Phone:706-490-3149
Mailing Address - Fax:706-782-5266
Practice Address - Street 1:44 COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-0000
Practice Address - Country:US
Practice Address - Phone:706-490-3149
Practice Address - Fax:706-782-5266
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT000089225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist