Healthcare Provider Details

I. General information

NPI: 1962880518
Provider Name (Legal Business Name): KEITH PATTERSON L.A.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 SPEEGLEVILLE RD
MCGREGOR TX
76657-4129
US

IV. Provider business mailing address

4750 SPEEGLEVILLE RD
MCGREGOR TX
76657-4129
US

V. Phone/Fax

Practice location:
  • Phone: 254-644-3248
  • Fax:
Mailing address:
  • Phone: 254-644-3248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT1847
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: