Provider Demographics
NPI:1902204928
Name:FLORES, PATTY (RPT)
Entity Type:Individual
Prefix:
First Name:PATTY
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:PATTY
Other - Middle Name:DE JESUS
Other - Last Name:SOBREMONTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1611 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-4637
Mailing Address - Country:US
Mailing Address - Phone:206-445-5226
Mailing Address - Fax:
Practice Address - Street 1:1611 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-4637
Practice Address - Country:US
Practice Address - Phone:206-445-5226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60014896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist