Provider Demographics
NPI:1619164506
Name:CREATORE, PATRICIA JOAN (LPT)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:JOAN
Last Name:CREATORE
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 889
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-0889
Mailing Address - Country:US
Mailing Address - Phone:330-533-8871
Mailing Address - Fax:330-965-7666
Practice Address - Street 1:1113 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-5662
Practice Address - Country:US
Practice Address - Phone:919-360-7762
Practice Address - Fax:919-882-1555
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC250188Medicare PIN