Provider Demographics
NPI:1477557080
Name:CROSS, PATRICK STEPHEN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:STEPHEN
Last Name:CROSS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MUIRFIELD CT
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-7076
Mailing Address - Country:US
Mailing Address - Phone:605-202-0997
Mailing Address - Fax:
Practice Address - Street 1:100 INDIAN HILLS DRIVE
Practice Address - Street 2:
Practice Address - City:MACY
Practice Address - State:NE
Practice Address - Zip Code:68039
Practice Address - Country:US
Practice Address - Phone:402-837-4190
Practice Address - Fax:402-837-5303
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2142225100000X
SD1349225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470550261-26Medicaid
NE470550261-26Medicaid