Provider Demographics
NPI:1255377768
Name:FAVAZZA, PATRICK ANDREW (ATC)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:ANDREW
Last Name:FAVAZZA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32 HANG DONG
Mailing Address - Street 2:
Mailing Address - City:CHIANG MAI
Mailing Address - State:CHAING MAI
Mailing Address - Zip Code:50230
Mailing Address - Country:TH
Mailing Address - Phone:665-313-1175
Mailing Address - Fax:
Practice Address - Street 1:178/832 MOO7
Practice Address - Street 2:HANG DONG
Practice Address - City:CHIANG MAI
Practice Address - State:CHAING MAI
Practice Address - Zip Code:50230
Practice Address - Country:TH
Practice Address - Phone:665-313-1175
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer