Provider Demographics
NPI:1952174021
Name:PATTON, JAMIE LEA (PTA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEA
Last Name:PATTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LEA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:415 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5026
Mailing Address - Country:US
Mailing Address - Phone:326-401-2304
Mailing Address - Fax:
Practice Address - Street 1:415 W 5TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5026
Practice Address - Country:US
Practice Address - Phone:432-640-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2106200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant