Provider Demographics
NPI:1821621798
Name:PATTERSON, FATIMA SHAARAN (LMT)
Entity Type:Individual
Prefix:MS
First Name:FATIMA
Middle Name:SHAARAN
Last Name:PATTERSON
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 1:5350 FOSSIL CREEK BLVD APT 812
Mailing Address - Street 2:
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76137-6236
Mailing Address - Country:US
Mailing Address - Phone:214-240-7232
Mailing Address - Fax:
Practice Address - Street 1:5208 AIRPORT FWY STE 167
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76117-5922
Practice Address - Country:US
Practice Address - Phone:214-240-7232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT129314225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMT129314OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION