Provider Demographics
NPI:1538143938
Name:PATTERSON, JASMINE LAUREL (BS, MS)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:LAUREL
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:
Other - Last Name:GUSTAFSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8750 GREENWOOD AVE N, SUITE S-1
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103
Mailing Address - Country:US
Mailing Address - Phone:206-782-5789
Mailing Address - Fax:206-782-5794
Practice Address - Street 1:8750 GREENWOOD AVE N, SUITE S-1
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103
Practice Address - Country:US
Practice Address - Phone:206-782-5789
Practice Address - Fax:206-782-5794
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009254225100000X
OR4663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8372823Medicaid
WAAB40120Medicare PIN