Provider Demographics
NPI:1770652315
Name:DOUGLAS, PATRICIA A (LMT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 SNOW ST
Mailing Address - Street 2:SUITE 17
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-1987
Mailing Address - Country:US
Mailing Address - Phone:256-832-3112
Mailing Address - Fax:
Practice Address - Street 1:1225 SNOW ST
Practice Address - Street 2:SUITE 17
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1987
Practice Address - Country:US
Practice Address - Phone:256-832-3112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1727225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist