Provider Demographics
NPI:1366682296
Name:PATTERSON, KATHRYN S (LMT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 EUNICE RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2613
Mailing Address - Country:US
Mailing Address - Phone:863-670-2466
Mailing Address - Fax:
Practice Address - Street 1:110 E PINE ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4965
Practice Address - Country:US
Practice Address - Phone:863-670-2466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA49674225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist