Provider Demographics
NPI:1407172547
Name:BATDORF, PATRICIA JO (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JO
Last Name:BATDORF
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:JO
Other - Last Name:HACKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:211 S BOUNDARY AVE
Mailing Address - Street 2:
Mailing Address - City:PROCTOR
Mailing Address - State:MN
Mailing Address - Zip Code:55810-2306
Mailing Address - Country:US
Mailing Address - Phone:218-624-4819
Mailing Address - Fax:218-628-1191
Practice Address - Street 1:211 S BOUNDARY AVE
Practice Address - Street 2:
Practice Address - City:PROCTOR
Practice Address - State:MN
Practice Address - Zip Code:55810-2306
Practice Address - Country:US
Practice Address - Phone:218-624-4819
Practice Address - Fax:218-628-1191
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1524225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1407172547Medicaid
MN1407172547Medicaid
WI1407172547Medicaid