Provider Demographics
NPI:1275906604
Name:WESTOVER, PATRICIA LYNN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LYNN
Last Name:WESTOVER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:LYNN
Other - Last Name:OLDENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1055 FOREST HILL AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3626
Mailing Address - Country:US
Mailing Address - Phone:616-942-1990
Mailing Address - Fax:
Practice Address - Street 1:1055 FOREST HILL AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3626
Practice Address - Country:US
Practice Address - Phone:616-942-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017228225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist