Provider Demographics
NPI:1396769956
Name:PATANE, PATRICIA M (ATC, PT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:PATANE
Suffix:
Gender:F
Credentials:ATC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JENNIFER LN
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-9663
Mailing Address - Country:US
Mailing Address - Phone:802-362-5831
Mailing Address - Fax:
Practice Address - Street 1:90 JENNIFER LN
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-9663
Practice Address - Country:US
Practice Address - Phone:802-362-5831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003585225100000X
VT104-00001112255A2300X
NY62-022037225100000X
NY000798-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00059975OtherBLUE CROSS BLUE SHIELD
VT1010523Medicaid
4123886OtherMVP
QC4721Medicare ID - Type Unspecified
PAVN3396Medicare ID - Type Unspecified