Provider Demographics
NPI:1609080043
Name:PATRICK, RHETT SHANNAN (MS, MPT)
Entity Type:Individual
Prefix:MR
First Name:RHETT
Middle Name:SHANNAN
Last Name:PATRICK
Suffix:
Gender:M
Credentials:MS, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10542 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2332
Mailing Address - Country:US
Mailing Address - Phone:818-795-8917
Mailing Address - Fax:310-838-9992
Practice Address - Street 1:10542 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2332
Practice Address - Country:US
Practice Address - Phone:310-838-3331
Practice Address - Fax:310-838-9992
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist