Provider Demographics
NPI:1659703189
Name:PATTERSON, JACQUELINE DAVIS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:DAVIS
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 LINDELL BLVD
Mailing Address - Street 2:APT 204
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3723
Mailing Address - Country:US
Mailing Address - Phone:734-678-8424
Mailing Address - Fax:314-735-4468
Practice Address - Street 1:4616 LINDELL BLVD
Practice Address - Street 2:APT 204
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3723
Practice Address - Country:US
Practice Address - Phone:734-678-8424
Practice Address - Fax:314-735-4468
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013028646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist