Provider Demographics
NPI:1831248624
Name:PATTON, KATHERINE (PT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:PATTON
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 1:555 SUN VALLEY DR STE G2
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5607
Mailing Address - Country:US
Mailing Address - Phone:678-393-8636
Mailing Address - Fax:678-393-8637
Practice Address - Street 1:555 SUN VALLEY DR STE G2
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5607
Practice Address - Country:US
Practice Address - Phone:678-393-8636
Practice Address - Fax:678-393-8637
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBCLDMedicare ID - Type Unspecified
GAQ10558Medicare UPIN