Provider Demographics
NPI:1689954414
Name:PATTERSON, KAYTIE E (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KAYTIE
Middle Name:E
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:KAYTIE
Other - Middle Name:E
Other - Last Name:LOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:500 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-5204
Mailing Address - Country:US
Mailing Address - Phone:479-968-1198
Mailing Address - Fax:479-967-1178
Practice Address - Street 1:306 E 11TH ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-6156
Practice Address - Country:US
Practice Address - Phone:479-968-1198
Practice Address - Fax:479-967-1178
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 2457225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant