Provider Demographics
NPI:1558373787
Name:PATERSON, NANCY LEE (PTA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LEE
Last Name:PATERSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-2922
Mailing Address - Country:US
Mailing Address - Phone:714-879-7836
Mailing Address - Fax:
Practice Address - Street 1:1632 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-2922
Practice Address - Country:US
Practice Address - Phone:714-879-7836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT764225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant