Provider Demographics
NPI:1962635631
Name:PUTNEY, PATRICIA IRENE (LPTA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:IRENE
Last Name:PUTNEY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-4660
Mailing Address - Country:US
Mailing Address - Phone:315-783-7439
Mailing Address - Fax:
Practice Address - Street 1:417 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-4660
Practice Address - Country:US
Practice Address - Phone:315-783-7439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3991225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant