Provider Demographics
NPI:1588807754
Name:PATTERSON, BRYAN ELLIOTT (PT)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:ELLIOTT
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 COLUMBIA CIR
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79553-4903
Mailing Address - Country:US
Mailing Address - Phone:325-660-0568
Mailing Address - Fax:
Practice Address - Street 1:120 S SWENSON ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:TX
Practice Address - Zip Code:79553-4624
Practice Address - Country:US
Practice Address - Phone:325-773-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154607225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist