Provider Demographics
NPI:1952734774
Name:PREASTER, PATRICIA
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:PREASTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5022 GULFPORT BLVD S
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4942
Mailing Address - Country:US
Mailing Address - Phone:727-851-2167
Mailing Address - Fax:727-289-7213
Practice Address - Street 1:5022 GULFPORT BLVD S
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:FL
Practice Address - Zip Code:33707-4942
Practice Address - Country:US
Practice Address - Phone:727-851-2167
Practice Address - Fax:727-289-7213
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist