Provider Demographics
NPI:1164813622
Name:PATTERSON, AUDRIE
Entity Type:Individual
Prefix:
First Name:AUDRIE
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3566 WILSON WOODS DR
Mailing Address - Street 2:APT. G
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-1647
Mailing Address - Country:US
Mailing Address - Phone:801-636-1983
Mailing Address - Fax:
Practice Address - Street 1:1840 ZOLLINGER RD
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2850
Practice Address - Country:US
Practice Address - Phone:614-442-6754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.022031172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist