Provider Demographics
NPI:1780834002
Name:REID, PATRICE ELEASE (AAS)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:ELEASE
Last Name:REID
Suffix:
Gender:F
Credentials:AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 VERONICA PL FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5418
Mailing Address - Country:US
Mailing Address - Phone:347-260-3718
Mailing Address - Fax:
Practice Address - Street 1:160 VERONICA PL FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-5418
Practice Address - Country:US
Practice Address - Phone:347-260-3718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003128225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant