MEDICARE: PAULINE ROSE PATTERSON MPT, OCS, ART

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	PT19839	CA

General Provider Information

NPI Number	:	1528032455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULINE ROSE PATTERSON MPT, OCS, ART

Provider Business Mailing Address
First Line	:	7212 DIAMOND TAIL DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4263
Country	:	US
Telephone Number	:	970-222-5790
Fax Number	:	510-923-1944

Provider Business Practice Location Address
First Line	:	2001 S SHIELDS ST
Second Line	:	BLDG D, SUITE #204
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1827
Country	:	US
Telephone Number	:	970-222-5790
Fax Number	:	510-923-1944

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	01/30/2017

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