Provider Demographics
NPI:1205542909
Name:PATTERSON, CLINTON VAN (PT)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:VAN
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 1:5421 MAGNOLIA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-5911
Mailing Address - Country:US
Mailing Address - Phone:352-217-2827
Mailing Address - Fax:
Practice Address - Street 1:1114 BICHARA BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-7716
Practice Address - Country:US
Practice Address - Phone:352-577-0832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18822225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist