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NPI Code Detail

MEDICARE: MR. BRYAN JOSEPH PATTERSON P.T.A.

MEDICARE: MR. BRYAN JOSEPH PATTERSON P.T.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant000929WV

General Provider Information

NPI Number : 1073632352
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRYAN JOSEPH PATTERSON P.T.A.
Provider Business Mailing Address
First Line : 3 WAKEFIELD RD
Second Line :
City : POINT PLEASANT
State : WV
Zip : 25550-1735
Country : US
Telephone Number : 304-638-4811
Fax Number :
Provider Business Practice Location Address
First Line : 1000 ASSOCIATION DR
Second Line :
City : CHARLESTON
State : WV
Zip : 25311-1270
Country : US
Telephone Number : 304-347-4372
Fax Number : 304-347-8526
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2007
Last Update Date : 07/08/2007

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