Provider Demographics
NPI:1265709836
Name:PATTERSON, ELETREA (LMT)
Entity type:Individual
Prefix:
First Name:ELETREA
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4980 S ALMA SCHOOL RD
Mailing Address - Street 2:A2190
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-5545
Mailing Address - Country:US
Mailing Address - Phone:480-628-5103
Mailing Address - Fax:
Practice Address - Street 1:15233 N 87TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2646
Practice Address - Country:US
Practice Address - Phone:480-991-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-10768225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist