Provider Demographics
NPI:1215369079
Name:PATRICK, DAVID A (DPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:PATRICK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6006 MAHONING AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2239
Mailing Address - Country:US
Mailing Address - Phone:330-755-3000
Mailing Address - Fax:330-599-7008
Practice Address - Street 1:6006 MAHONING AVE
Practice Address - Street 2:SUITE G
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2239
Practice Address - Country:US
Practice Address - Phone:330-755-3000
Practice Address - Fax:330-599-7008
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT014400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist