Provider Demographics
NPI:1679819502
Name:PATERSON, DAWN MARIE (LMT/PTA)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:MARIE
Last Name:PATERSON
Suffix:
Gender:F
Credentials:LMT/PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8504 POSSOM TROT RD
Mailing Address - Street 2:
Mailing Address - City:RAYMONDVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65555-8157
Mailing Address - Country:US
Mailing Address - Phone:417-260-4242
Mailing Address - Fax:
Practice Address - Street 1:8504 POSSOM TROT RD
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:MO
Practice Address - Zip Code:65555-8157
Practice Address - Country:US
Practice Address - Phone:417-260-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005001378225200000X
MO2021042425225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant