Provider Demographics
NPI:1558347864
Name:PATTON, GLENDA (PT)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:PATTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 COBURG ROAD #5
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5200
Mailing Address - Country:US
Mailing Address - Phone:541-345-7532
Mailing Address - Fax:541-345-6692
Practice Address - Street 1:1310 COBURG ROAD #5
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5200
Practice Address - Country:US
Practice Address - Phone:541-345-7532
Practice Address - Fax:541-345-6692
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR084171005OtherBCBS
OR023169Medicaid
ORR141887Medicare PIN