Healthcare Provider Details

I. General information

NPI: 1780700831
Provider Name (Legal Business Name): CAROLE PATTERSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 SLAUGHTER RD SUITE F
MADISON AL
35758-5900
US

IV. Provider business mailing address

17138 FREEDOM DR
ATHENS AL
35613-6449
US

V. Phone/Fax

Practice location:
  • Phone: 256-430-9756
  • Fax: 256-430-9757
Mailing address:
  • Phone: 256-232-2063
  • Fax: 256-430-9757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1501
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: