Provider Demographics
NPI:1417957044
Name:MCBRIDE, PATRICK S (DPT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:S
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N LAVENTURE RD
Mailing Address - Street 2:STE A
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-3901
Mailing Address - Country:US
Mailing Address - Phone:360-428-2700
Mailing Address - Fax:360-428-2701
Practice Address - Street 1:110 N LAVENTURE RD
Practice Address - Street 2:STE A
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3901
Practice Address - Country:US
Practice Address - Phone:360-428-2700
Practice Address - Fax:360-428-2701
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00006691OtherRAILROAD MEDICARE
WA7155104Medicaid
WAP87497Medicare UPIN
WAGAB36878Medicare PIN