Provider Demographics
NPI:1649201435
Name:PATTERSON, MICHAEL WILSON (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WILSON
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 1:650 RITCHIE HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3916
Mailing Address - Country:US
Mailing Address - Phone:410-647-1961
Mailing Address - Fax:410-647-8276
Practice Address - Street 1:650 RITCHIE HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3916
Practice Address - Country:US
Practice Address - Phone:410-647-1961
Practice Address - Fax:410-647-8276
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD270P573GMedicare PIN