Basic Information
| Provider Information | |||||||||
| NPI: | 1528032455 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATTERSON | ||||||||
| FirstName: | PAULINE | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | MPT, OCS, ART | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7212 DIAMOND TAIL DR | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805254263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702225790 | ||||||||
| FaxNumber: | 5109231944 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 S SHIELDS ST | ||||||||
| Address2: | BLDG D, SUITE #204 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805261827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702225790 | ||||||||
| FaxNumber: | 5109231944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 01/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT19839 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.