Provider Demographics
NPI:1780700831
Name:PATTERSON, CAROLE (LMT)
Entity type:Individual
Prefix:
First Name:CAROLE
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 1:17138 FREEDOM DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-6449
Mailing Address - Country:US
Mailing Address - Phone:256-232-2063
Mailing Address - Fax:256-430-9757
Practice Address - Street 1:1230 SLAUGHTER RD
Practice Address - Street 2:SUITE F
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-5900
Practice Address - Country:US
Practice Address - Phone:256-430-9756
Practice Address - Fax:256-430-9757
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1501225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist