Provider Demographics
NPI:1275052920
Name:PATTERSON, TRISTEN LEE
Entity Type:Individual
Prefix:
First Name:TRISTEN
Middle Name:LEE
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:
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 780942
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-0010
Mailing Address - Country:US
Mailing Address - Phone:334-415-8717
Mailing Address - Fax:
Practice Address - Street 1:4255 NOTASULGA RD
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-6033
Practice Address - Country:US
Practice Address - Phone:334-415-8717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer