Provider Demographics
NPI:1417401969
Name:PATTON, CHERYL DAWN (PTA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:DAWN
Last Name:PATTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 E OAK AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-2368
Mailing Address - Country:US
Mailing Address - Phone:813-247-1130
Mailing Address - Fax:813-655-8823
Practice Address - Street 1:313 E OAK AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-2368
Practice Address - Country:US
Practice Address - Phone:813-247-1130
Practice Address - Fax:813-655-8823
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23262225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant