Provider Demographics
NPI:1801973102
Name:PATTERSON-AVERY, MARTHA (PT)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:PATTERSON-AVERY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 PATTERSON LN
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-8301
Mailing Address - Country:US
Mailing Address - Phone:412-512-9623
Mailing Address - Fax:
Practice Address - Street 1:1985 LINCOLN WAY
Practice Address - Street 2:RAINBOW SHOPPING PLAZA
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15131-2418
Practice Address - Country:US
Practice Address - Phone:412-672-2352
Practice Address - Fax:412-672-2657
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA467320OtherOSPTA -BLUE SHIELD
PA968089OtherVOR'S BLUE SHIELD #
PA467320OtherOSPTA -BLUE SHIELD
PA396610Medicare ID - Type UnspecifiedOSPTA GROUP MEDICARE