MEDICARE: KAROLYN MASON PATTERSON PT

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
1	225100000X	Physical Therapist	PT3521	OK
2	225100000X	Physical Therapist	10178	NC
3	225100000X	Physical Therapist	2673	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00405089	OTHER	OK	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	079UE	OTHER	NC	BCBS PROVIDER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	10178	OTHER	NC	NC STATE LICENSE
6	460487007	OTHER	OK	TRICARE

General Provider Information

NPI Number	:	1437233681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAROLYN MASON PATTERSON PT

Provider Business Mailing Address
First Line	:	1932 N BROADWAY ST
Second Line	:	SUITE B
City	:	POTEAU
State	:	OK
Zip	:	74953-2501
Country	:	US
Telephone Number	:	918-649-0919
Fax Number	:	918-647-0979

Provider Business Practice Location Address
First Line	:	2104 N BROADWAY ST
Second Line	:	SUITEB
City	:	POTEAU
State	:	OK
Zip	:	74953-2501
Country	:	US
Telephone Number	:	918-640-0799
Fax Number	:	918-649-0797

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	05/28/2014

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Directions to “ KAROLYN MASON PATTERSON PT” Practice Location

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