Healthcare Provider Details

I. General information

NPI: 1487100525
Provider Name (Legal Business Name): REBECCA ELAINE PATTERSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 CITY CENTER PKWY
PORT ORANGE FL
32129-4153
US

IV. Provider business mailing address

4701 CITY CENTER PKWY
PORT ORANGE FL
32129-4153
US

V. Phone/Fax

Practice location:
  • Phone: 386-304-7660
  • Fax: 386-304-7662
Mailing address:
  • Phone: 386-304-7660
  • Fax: 386-304-7662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA24212
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: