Provider Demographics
NPI:1609094689
Name:FREIMUTH, PATTI LYNN (DT)
Entity Type:Individual
Prefix:MRS
First Name:PATTI
Middle Name:LYNN
Last Name:FREIMUTH
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1793 EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:VA
Mailing Address - Zip Code:23093-2953
Mailing Address - Country:US
Mailing Address - Phone:217-519-1589
Mailing Address - Fax:
Practice Address - Street 1:1793 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:VA
Practice Address - Zip Code:23093-2953
Practice Address - Country:US
Practice Address - Phone:217-519-1589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILPF55380307P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist