Provider Demographics
NPI:1275817330
Name:PATTERSON, DANIEL RYAN (DPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:RYAN
Last Name:PATTERSON
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:SUITE 4761 LAKE MICHIGAN DR NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-6300
Mailing Address - Country:US
Mailing Address - Phone:616-281-1144
Mailing Address - Fax:616-940-1965
Practice Address - Street 1:721 THREE MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-8230
Practice Address - Country:US
Practice Address - Phone:616-608-8933
Practice Address - Fax:616-285-1154
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist