Provider Demographics
NPI:1750311908
Name:PATTERSON PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:PATTERSON PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-647-1961
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16229225100000X
MD16203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
N126-0003OtherBCBS
MD89575801OtherCAREFIRST
MD52908331OtherCAREFIRST
MDN126-0001OtherBCBS
MD52100440OtherCAREFIRST
MDN126-0002OtherBCBS
MDN126-0002OtherBCBS