Healthcare Provider Details

I. General information

NPI: 1710019807
Provider Name (Legal Business Name): STEVEN J PATTERSON ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 COLLEGE AVE
DAVIE FL
33314-7721
US

IV. Provider business mailing address

8030 LAKEPOINTE DR BLDG #2
PLANTATION FL
33322-5725
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-8330
  • Fax:
Mailing address:
  • Phone: 954-370-8410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL 1912
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: