Provider Demographics
NPI:1639543192
Name:LIN, PATTIE (DPT)
Entity Type:Individual
Prefix:
First Name:PATTIE
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S SANTA FE AVE
Mailing Address - Street 2:3-516
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-3100
Mailing Address - Country:US
Mailing Address - Phone:443-538-4836
Mailing Address - Fax:
Practice Address - Street 1:408 W 11TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-2102
Practice Address - Country:US
Practice Address - Phone:443-538-4836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT292562225100000X
TX1263810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist