Provider Demographics
NPI:1194487298
Name:PATTON, ALYSSA RAE
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:RAE
Last Name:PATTON
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 1:11890 N PEBBLE LN
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46799-9017
Mailing Address - Country:US
Mailing Address - Phone:630-841-6401
Mailing Address - Fax:
Practice Address - Street 1:1010 W WASHINGTON CENTER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-4155
Practice Address - Country:US
Practice Address - Phone:630-841-6401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist