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General NPI Number Information
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NPI Number | 1275052920
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Entity Type | Individual
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Provider Name | TRISTEN LEE PATTERSON
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Gender | Male
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 4255 NOTASULGA RD
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City | TALLASSEE
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State | AL
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Zip | 36078-6033
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Country | US
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Telephone | 334-415-8717
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Fax |
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Provider Business Mailing Address
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Address Line | 535 GLYNN ST S STE 2008
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-2029
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Country | US
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Telephone | 707-033-1437
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Fax | 770-703-3162
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT016209
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License Number State | GA
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