Provider Demographics
NPI:1508040114
Name:PATTEN, MARK A (MSPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:PATTEN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5939 WAR ADMIRAL DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-5542
Mailing Address - Country:US
Mailing Address - Phone:813-973-1387
Mailing Address - Fax:
Practice Address - Street 1:5939 WAR ADMIRAL DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-5542
Practice Address - Country:US
Practice Address - Phone:813-973-1387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist