Provider Demographics
NPI:1013261916
Name:PATTERSON, KENNETH A (PT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:A
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13809 INDUSTRIAL RD
Mailing Address - Street 2:ATHLETES TRAINING CENTER
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137
Mailing Address - Country:US
Mailing Address - Phone:402-932-7111
Mailing Address - Fax:402-932-6878
Practice Address - Street 1:13809 INDUSTRIAL RD.
Practice Address - Street 2:ATHLETES TRAINING CENTER
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137
Practice Address - Country:US
Practice Address - Phone:402-932-7111
Practice Address - Fax:402-932-6878
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ66022251S0007X, 2251X0800X
NE1989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic