Provider Demographics
NPI:1326117631
Name:PATTERSON PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PATTERSON PHYSICAL THERAPY
Other - Org Name:OMEGA SOLUTIONS IN REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:805-230-2673
Mailing Address - Street 1:325 E ROLLING OAKS DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361
Mailing Address - Country:US
Mailing Address - Phone:805-230-2673
Mailing Address - Fax:805-230-2134
Practice Address - Street 1:325 E ROLLING OAKS DR
Practice Address - Street 2:SUITE 250
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361
Practice Address - Country:US
Practice Address - Phone:805-230-2673
Practice Address - Fax:805-230-2134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19840225100000X, 2251S0007X
CAMPT19840225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S81676Medicare UPIN
CAW17180Medicare ID - Type Unspecified