Provider Demographics
NPI:1528032455
Name:PATTERSON, PAULINE ROSE (MPT, OCS, ART)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:ROSE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MPT, OCS, ART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7212 DIAMOND TAIL DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4263
Mailing Address - Country:US
Mailing Address - Phone:970-222-5790
Mailing Address - Fax:510-923-1944
Practice Address - Street 1:2001 S SHIELDS ST
Practice Address - Street 2:BLDG D, SUITE #204
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1827
Practice Address - Country:US
Practice Address - Phone:970-222-5790
Practice Address - Fax:510-923-1944
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1528032455Medicare NSC