Provider Demographics
NPI:1750991600
Name:PATTILLO, SAMUEL LEE (PT)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:LEE
Last Name:PATTILLO
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 1:31 HAMPDEN RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805
Mailing Address - Country:US
Mailing Address - Phone:828-774-7391
Mailing Address - Fax:
Practice Address - Street 1:900 HENDERSONVILLE RD
Practice Address - Street 2:STE 201B
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1753
Practice Address - Country:US
Practice Address - Phone:828-774-7391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist