Provider Demographics
NPI:1184010068
Name:DRAGOONE, R. PATRICK (MS, LAT, CES)
Entity Type:Individual
Prefix:
First Name:R. PATRICK
Middle Name:
Last Name:DRAGOONE
Suffix:
Gender:M
Credentials:MS, LAT, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 RIVER DR
Mailing Address - Street 2:201
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109-2830
Mailing Address - Country:US
Mailing Address - Phone:484-273-4447
Mailing Address - Fax:484-273-4436
Practice Address - Street 1:701 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18101-2407
Practice Address - Country:US
Practice Address - Phone:484-273-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0050402255A2300X
WVAT0011932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer