Provider Demographics
NPI:1750319745
Name:PATTERSON, REID J (PT)
Entity Type:Individual
Prefix:
First Name:REID
Middle Name:J
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 1:4776 N FIVE MILE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-2715
Mailing Address - Country:US
Mailing Address - Phone:208-658-9500
Mailing Address - Fax:208-658-9501
Practice Address - Street 1:4776 N FIVE MILE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-2715
Practice Address - Country:US
Practice Address - Phone:208-658-9500
Practice Address - Fax:208-658-9501
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009177225100000X
ID2288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8405433Medicaid