Basic Information
Provider Information
NPI: 1205554961
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATTON
FirstName: ANDREW
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3276
Address2:  
City: EVANSVILLE
State: IN
PostalCode: 477313276
CountryCode: US
TelephoneNumber: 8124911390
FaxNumber: 8124926390
Practice Location
Address1: 418 W 3RD ST
Address2:  
City: OWENSBORO
State: KY
PostalCode: 423010704
CountryCode: US
TelephoneNumber: 2709268145
FaxNumber: 2709268147
Other Information
ProviderEnumerationDate: 08/18/2022
LastUpdateDate: 08/18/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/18/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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